First Author: D.Mohabati NETHERLANDS
Co Author(s): W. Chung E. van Dijk G. Dijkman C. Hoyng S. Yzer C. Boon
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Polypoidal choroidal vasculopathy (PCV) can be seen as a subtype of neovascular age-related macular degeneration (nAMD) as it shares similarities with nAMD. The prevalence of PCV is common and has been studied extensively in the Asian population, where it is more common than in the Caucasian population. Little is known about PCV in Caucasians. Therefore, the purpose of this study was to investigate the clinical characteristics and therapeutic outcome of PCV in a Caucasian population.
A retrospective review of charts was performed at the Department of Ophthalmology of Leiden University Medical centre, the Netherlands.
Medical records were analyzed. Patients were included if they met all of the following inclusion criteria: 1) Caucasian ethnicity (defined at least by the name of the patient); 2) a diagnosis of PCV confirmed by findings of typical single or multiple hyperfluorescent focal areas within 6 minutes on indocyanine green angiography (ICGA); 3) at least 1 visit after initial treatment. Exclusion criteria were any of the following: 1) insufficient ICGA quality to judge the possible presence of PCV; 2) the presence of (a) polyp(s) within the context of a disease other than PCV; 3) insufficient clinical data at diagnosis. After selection, the included patients were divided in the following 4 subtypes based on the clinical spectrum of PCV that can be seen in daily practice: 1) PCV within the context of nAMD with the presence of ≥5 drusen; 2) PCV in combination with a neovascularization / branching vascular network without signs of AMD (i.e. the appearance of <5 drusen; 3) idiopathic polyps without signs of drusen or neovascularisation / branching vascular network. Information regarding best-corrected visual acuity (BCVA) was collected at initial diagnosis (baseline), at the first visit after initial treatment, and 6, 12, and 24 months after initial treatment.
Out of 182 patients, 73 eyes from 66 patients (24 males, 42 females) met the inclusion criteria and were analyzed. The mean age at onset was 73 years (range: 51-90 years). The mean BCVA at baseline was 66 ETDRS letters. At the first visit after initial treatment the mean BCVA was 68 ETDRS letters, and 6, 12, and 24 months after initial treatment the mean BCVA was 74, 70, and 63 ETDRS letters, respectively. No significant change in mean BCVA occurred during this time. The distribution of study group consisted of the following: 37 eyes (51%) were classified as type 1, 13 eyes (18%) as type 2, and 23 eyes (32%) as type 3. An initial misdiagnosis of nAMD without PCV was present in 51% of the patients, of whom 70% were referred from a hospital elsewhere, and these patients initially received anti-vascular endothelial growth factor monotherapy.
Polypoidal choroidal vasculopathy may be more common in Caucasians than previously thought, as these patients may initially be misdiagnosed with nAMD without PCV. This misdiagnosis may lead to initial suboptimal treatment. Treatment requirements and outcome may differ between the 3 subtypes of PCV.