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POLYPOIDAL CHOROIDAL VASCULOPATHY: Evidence-Based Guidelines for Clinical Diagnosis and Treatment

Koh, Adrian H.C. MD*; Chen, Lee-Jen MD; Chen, Shih-Jen MD; Chen, Youxin MD§; Giridhar, Anantharam MD; Iida, Tomohiro MD**,††; Kim, Hakyoung MD‡‡; Lai, Timothy Yuk Yau MD§§; Lee, Won Ki MD¶¶; Li, Xiaoxin MD, PhD***; Han Lim, Tock MMED(OPHTH), FRCS(EDIN)†††; Ruamviboonsuk, Paisan MD‡‡‡; Sharma, Tarun MD, FRCS ED, MBA§§§; Tang, Shibo MD¶¶¶; Yuzawa, Mitsuko MD****on behalf of the Expert PCV Panel

doi: 10.1097/IAE.0b013e3182852446

Background: Polypoidal choroidal vasculopathy (PCV) is an exudative maculopathy affecting vision, with clinical features distinct from neovascular age-related macular degeneration. Currently, no evidence-based guidelines exist for its diagnosis and treatment.

Methods: A panel of experts analyzed a systematic literature search on PCV together with results of the EVEREST trial, the only published randomized controlled clinical trial in PCV. At a subsequent Roundtable meeting, recommendations for the management of PCV were agreed based on this analysis and their own expert opinion.

Results: Diagnosis of PCV should be based on early-phase nodular hyperfluorescence from choroidal vasculature visualized using indocyanine green angiography. Recommended initial treatment of juxtafoveal and subfoveal PCV is either indocyanine green angiography-guided verteporfin photodynamic therapy or verteporfin photodynamic therapy plus 3 × 0.5 mg ranibizumab intravitreal injections 1 month apart. If there is incomplete regression of polyps by indocyanine green angiography, eyes should be retreated with verteporfin photodynamic therapy monotherapy or verteporfin photodynamic therapy plus ranibizumab. If there is complete regression of polyps by indocyanine green angiography, but there is leakage on fluorescein angiography and other clinical or anatomical signs of disease activity, eyes should be retreated with ranibizumab.

Conclusion: Practical guidance on the clinical management of PCV is proposed based on expert evaluation of current evidence.

A panel of international experts convened a Roundtable meeting in Singapore in May 2010 to conclude discussions and agree consensus recommendations for the management of polypoidal choroidal vasculopathy. Practical guidance on the clinical management of polypoidal choroidal vasculopathy is proposed based on their evaluation of available evidence in conjunction with their own expert opinion.

*Eye & Retina Surgeons, Camden Medical Centre, Singapore;

Department of Ophthalmology, Mackay Memorial Hospital, Taipei, Taiwan;

Department of Ophthalmology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan;

§Department of Ophthalmology, Peking Union Medical College Hospital, Beijing, China;

Giridhar Eye Institute, Kadavanthra, Kochi, Kerala, India;

**Department of Ophthalmology, Tokyo Women’s Medical University, Tokyo, Japan;

††Department of Ophthalmology, Fukushima Medical University, Fukushima, Japan;

‡‡Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University, South Korea;

§§Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, NT, Hong Kong;

¶¶Department of Ophthalmology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea;

***Department of Ophthalmology, People’s Hospital, Peking University, Beijing, China;

†††National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore;

‡‡‡Department of Ophthalmology, Rajavithi Hospital, Bangkok, Thailand;

§§§Sankara Nethralaya, Chennai, Tamil Nadu, India;

¶¶¶Zhong Shan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China;

****Department of Ophthalmology, Surugadai Nihon University Hospital, Surugadai, Kanda, Chiyoda-ku, Tokyo, Japan.

Reprint requests: Adrian H.C. Koh, MD, Eye & Retina Surgeons, Camden Medical Centre, #13-03 Camden Medical Centre, 1 Orchard Boulevard, Singapore 248649, Singapore; e-Email:

Dr Timothy Lai serves on the advisory board of Novartis Pharmaceuticals Corporation and has received honorarium payment. All other authors have no financial interest to disclose.

Sponsorship for the Roundtable meeting was provided by Novartis Pharma AG, which also provided an unrestricted educational grant to the College of Ophthalmologists, Singapore.

© The Ophthalmic Communications Society, Inc.