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A novel polypoidal choroidal vasculopathy classification and its impact on long-term clinical outcomes

Session Details

Session Title: AMD II

Session Date/Time: Friday 18/09/2015 | 14:30-16:00

Paper Time: 14:38

Venue: Calliope.

First Author: : C.Tan SINGAPORE

Co Author(s): :    W. Ngo   L. Lim   T. Lim        

Abstract Details

PURPOSE:Polypoidal choroidal vasculopathy (PCV) has high prevalence among Asians, with variable clinical course and visual prognosis. We aimed to describe a classification system for PCV subtypes based on indocyanine-green (ICG) angiography, and correlate the subtypes with long-term clinical outcomes.

Setting:

Medical Retina service in a tertiary ophthalmic center in Singapore.

Methods:

Interventional longitudinal 5-year study of 107 consecutive PCV patients diagnosed using the EVEREST criteria. Images were independently graded by two Consultant ophthalmologists. The angiographic characteristics included the nature of the abnormal vascular channels, and the presence of leakage on fluorescein angiography. Based on these, 3 subtypes of PCV were identified, and these were correlated to clinical outcomes.

Results:

Three distinct PCV subtypes were seen: Type A (inter-connecting channels)–22.4%; Type B (branching vascular network)–24.3%; Type C (active leakage)–53.3%. At all review periods, the highest rate of moderate visual loss occurred in Type C PCV, followed by Types B and A (35.3% vs. 8.7% vs. 0% at 1 year). Good visual outcomes (≥6/12) were highest in Type A, compared to Types B and C t 5 years (80% vs. 66.7% vs. 7.7%, p<0.001). Independent risk factors for visual outcomes were PCV subtype (odds ratio [OR] 53.7 for type C, p<0.001) and age (OR 1.06, p=0.044).

Conclusions:

We have established a novel classification system for PCV based on angiography. The angiographic characteristics of PCV are important prognostic indicators, with BVN associated with higher rates of angiographic leakage and poorer long-term visual outcomes. This classification system has potential application in clinical practice and multicenter randomized trials.

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