Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore.
National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.
Invest Ophthalmol Vis Sci. 2018 Feb 1;59(2):889-896. doi: 10.1167/iovs.17-22683.
The purpose of this study was to describe the characteristics of polypoidal choroidal vasculopathy (PCV) subtypes among patients from a multicenter randomized controlled trial and to determine the impact of PCV subtypes on clinical outcomes.
This was a prospective cohort study of 61 patients with macular PCV from the EVEREST study. Indocyanine green (ICGA) and fluorescein angiography (FA) obtained using standardized imaging protocols were graded to classify PCV into three subtypes. Type A PCV had polyps with interconnecting channels, type B had polyps with branching vascular networks, but no significant leakage on FA, and type C had polyps with branching vascular networks and leakage on FA. The best-corrected visual acuity (BCVA) and proportion of patients with BCVA ≥ 20/40 were compared among the three PCV subtypes.
Of the 61 patients, 54 were gradable for PCV subtype. Among these, 8 had type A PCV (14.8%), 27 had type B (50%), and 19 had type C (35.2%). At baseline, BCVA was 67.1 letters for type A, 58.7 for type B, and 43.5 for type C (P < 0.001). At 6 months, BCVA was highest among patients with type A compared with types B and C (80.1 letters versus 67.2 versus 50.4, respectively; P < 0.001). Type A PCV gained 13 letters compared with 8.5 (type B) and 6.9 (type C). BCVA ≥ 20/40 was highest for type A compared with types B and C (100% vs. 51.9% vs. 10.5%; P < 0.001). On performing ANCOVA, PCV subtype and baseline BCVA significantly affected final BCVA.
The visual outcome following treatment varies with PCV subtype classification. The distinction in clinical outcomes between the PCV subtypes is observed in the initial months following the start of treatment.
本研究旨在描述多中心随机对照试验中患者的息肉状脉络膜血管病变（PCV）亚型特征，并确定 PCV 亚型对临床结果的影响。
这是一项 EVEREST 研究中 61 例黄斑 PCV 患者的前瞻性队列研究。使用标准化成像方案获得吲哚菁绿（ICGA）和荧光素血管造影（FA），并进行分级以将 PCV 分为三种亚型。A 型 PCV 有具有相互连接的通道的息肉，B 型 PCV 有具有分支血管网络但 FA 上无明显渗漏的息肉，C 型 PCV 有具有分支血管网络和 FA 上渗漏的息肉。比较三种 PCV 亚型的最佳矫正视力（BCVA）和 BCVA≥20/40 的患者比例。
在 61 例患者中，有 54 例可对 PCV 亚型进行分级。其中，8 例为 A 型（14.8%），27 例为 B 型（50%），19 例为 C 型（35.2%）。基线时，A 型的 BCVA 为 67.1 个字母，B 型为 58.7 个字母，C 型为 43.5 个字母（P<0.001）。6 个月时，A 型患者的 BCVA 最高，与 B 型和 C 型相比（分别为 80.1 个字母、67.2 个字母和 50.4 个字母；P<0.001）。与 B 型（8.5 个字母）和 C 型（6.9 个字母）相比，A 型增加了 13 个字母。A 型的 BCVA≥20/40 比例最高，与 B 型和 C 型相比（100%比 51.9%比 10.5%；P<0.001）。进行 ANCOVA 后，PCV 亚型和基线 BCVA 显著影响最终 BCVA。
治疗后的视觉结果因 PCV 亚型分类而异。在治疗开始后的最初几个月就观察到 PCV 亚型之间的临床结果差异。
