Anti–Vascular Endothelial Growth Factor Resistance in Exudative Macular Degeneration and Polypoidal Choroidal Vasculopathy

Clinical Characteristics of Polypoidal Choroidal Vasculopathy and Anti-Vascular Endothelial Growth Factor Treatment Response in Caucasians

“…The usual location of the PCV complex in Caucasian patients in our series was the macular region (i.e., 80%), which is in contrast to the initial reports of peripapillary predominance [15]. Peripapillary PCV was seen in 17% of eyes, and often led to a characteristic pattern of scarring around the optic disc.…”

“…PCV is a subtype of exudative AMD which has been underrecognized in Caucasian populations, often due to the lack of imaging with ICGA in occult choroidal neovascularization associated with AMD [16,17]. A recent increase in the prevalence of PCV in exudative AMD in Caucasian patients, i.e., from 20 to 31%, has been reported [13][14][15]. This has been attributed to the use of SLO ICGA, which has been shown to be much more sensitive than fundus flash ICGA used in previous studies on PCV in Caucasians [9,10].…”

“…A study from Switzerland by Hatz and Prünte [18] reported a higher incidence of anti-VEGF resistance in Caucasian eyes with PCV, suggesting that alternative treatments to anti-VEGF monotherapy may need to be considered. PCV was also more prevalent in anti-VEGF resistant eyes with exudative AMD in both Asian and Caucasian patient populations in a study from Hawaii [15].…”

“…It was considered relatively uncommon in Caucasian patients [9,10], but with increasing experience in diagnosing PCV, more recent screening with ICGA, and the utilization of the more sensitive scanning laser ophthalmoscope (SLO) [11,12], a significantly higher prevalence is now being reported in this population. PCV prevalence was recently reported as being 20% in a predominantly Caucasian population in the PERSIST study conducted by the Duke Eye Center, Durham, NC, USA [13]; 24.5% in a population in Brazil of predominantly European ancestry [14]; and 31% in a Caucasian population in Hawaii [15].…”

“…However, ICGA is less frequently performed due to the low availability, the greater time commitment, the higher cost of dye and imaging equipment, and the lack of understanding and training in reading ICGA for PCV. For these reasons, the prevalence of PCV may be higher in Caucasian populations than previously recognized [13][14][15][16][17]. This underdiagnosis is problematic because there is a higher incidence of resistance to medications targeting vascular endothelial growth factor (VEGF) in PCV [15,[18][19][20] and other possible beneficial treatments for PCV other than anti-VEGF injections [3,15,21].…”