Goldhardt Raquel, Rosen Bradley Simon
Miami Veterans Administration Medical Center, Miami, FL, USA.
Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL.
Curr Ophthalmol Rep. 2019 Mar;7(1):66-72. doi: 10.1007/s40135-019-00201-4. Epub 2019 Feb 2.
The aim of this review is to summarize developments in the treatment of active polypoidal choroidal vasculopathy (PCV). PCV is associated with a poor visual prognosis as a consequence the condition's hallmark polypoidal dilatation and a branching network resulting in recurrent hemorrhages and serous leakage.
Recent research has provided new insights into the pathogenesis of PCV. While still considered a subtype of age-related macular degeneration, suggestions that PCV belongs to a spectrum of conditions that present with a pachychoroid are increasingly well accepted. Treatment remains challenging. Combination therapy (photodynamic therapy (PDT) and intravitreal anti-vascular endothelial growth factor (VEGF)) is associated with higher polyp closure rate, but polyp closure rate has not been correlated with superior visual outcomes. Current data points to non-inferiority of anti-VEGF alone versus combined with PDT when final vision acuity is the study outcome.
PCV remains a clinical challenge. Classification and treatment of the condition continues to evolve. Combination therapy may not be superior to anti-VEGF treatment alone in terms of visual acuity outcome, however data on long-term recurrence should be compared in formulating preferred treatment plans.
本综述旨在总结活动性息肉样脉络膜血管病变(PCV)治疗方面的进展。PCV因具有标志性的息肉样扩张和分支状血管网,易导致反复出血和浆液性渗漏,从而预后视力较差。
近期研究为PCV的发病机制提供了新见解。尽管PCV仍被视为年龄相关性黄斑变性的一种亚型,但越来越多的人接受了PCV属于厚脉络膜相关疾病谱的观点。治疗仍然具有挑战性。联合治疗(光动力疗法(PDT)和玻璃体内注射抗血管内皮生长因子(VEGF))息肉闭合率较高,但息肉闭合率与更好的视力预后并无关联。当以最终视力为研究结果时,目前的数据表明单独使用抗VEGF与联合PDT相比并无劣势。
PCV仍然是一项临床挑战。该疾病的分类和治疗仍在不断发展。就视力结果而言,联合治疗可能并不优于单独使用抗VEGF治疗,然而在制定首选治疗方案时,应比较长期复发的数据。