Abstract:PurposeTo describe screening failures in the EVEREST study by examining the imaging characteristics that enabled differentiation of polypoidal choroidal vasculopathy (PCV) from cases that were subsequently diagnosed not to be PCV.MethodsPost-hoc analysis of 34 patients with PCV reported as screening failures from EVEREST study. Standardised confocal scanning laser indocyanine green angiography (ICGA) images were graded by the Central Reading Centre to confirm PCV diagnosis based on the presence of early focal … Show more
“…PCV diagnosis was confirmed based on the EVEREST definition [8, 26, 27], including the presence of early focal subretinal hyperfluorescence on ICGA and at least one of the following six diagnostic criteria: (1) nodular appearance of polyp(s) on stereoscopic examination, (2) hypofluorescent halo around nodule(s), (3) presence of a branching vascular network, (4) Pulsatile filling of the polyps on dynamic ICGA, (5) orange subretinal nodules on color fundus photography, or (6) massive submacular hemorrhage (≥4 disc areas in size). Figures 1, 2
3 and Additional file 1: Video 1 further demonstrate some of the aforementioned diagnostic features.Fig.…”
Purpose To evaluate the characteristics and racial variations amongst patients with polypoidal choroidal vasculopathy (PCV) in the United States and the United Kingdom.MethodsFundus photos and indocyanine green angiography images were evaluated in a multicenter retrospective study to establish the diagnosis of PCV. Visual acuity (VA) was recorded in ETDRS letter count.ResultsEighty eyes of 71 PCV patients (average age of 69.4 ± 10.4 years) were included in the analysis. Of the total 71 subjects, 46 (65%) were women, 33 (46.5%) were Blacks, 16 (22.5%) were Whites, 19 (26.8%) were Asians and 3 (4.2%) belonged to other races. The Black subgroup had vision gain of 3.5 letters. The White and Asian subgroups had vision loss of 13.1 and 3.5 letters, respectively. There was female predominance in Blacks (67%), Whites (69%), and Asians (58%). PCV was found to be a bilateral disease in 14 patients (20%). There was significant decrease of 7 letters with every decade increase in age (p = 0.005). Final VA was worse in males when compared to females (p = 0.042), and worse in Whites when compared to Blacks (p = 0.005). For every 10 letters worse in initial VA upon diagnosis with PCV, the final VA was worse by 6 letters (p < 0.001). The location of the polypoidal lesion within the macula was associated with significant decrease of 14 letters in BCVA (p = 0.02). The length of follow up was significantly associated with worse visual outcome (p = 0.012). Final VA had no significant correlation with the lens status, or the different treatment modalities.ConclusionsBased on our cohort from tertiary centers in the United States and United Kingdom, PCV is a bilateral disease in one-fifth of patients. It features a variable female predominance based on ethnicity. Increased age, worse vision upon initial presentation, longer follow up and macular location of the polyp were associated with worse visual outcome.Electronic supplementary materialThe online version of this article (doi:10.1186/s40942-017-0060-4) contains supplementary material, which is available to authorized users.
“…PCV diagnosis was confirmed based on the EVEREST definition [8, 26, 27], including the presence of early focal subretinal hyperfluorescence on ICGA and at least one of the following six diagnostic criteria: (1) nodular appearance of polyp(s) on stereoscopic examination, (2) hypofluorescent halo around nodule(s), (3) presence of a branching vascular network, (4) Pulsatile filling of the polyps on dynamic ICGA, (5) orange subretinal nodules on color fundus photography, or (6) massive submacular hemorrhage (≥4 disc areas in size). Figures 1, 2
3 and Additional file 1: Video 1 further demonstrate some of the aforementioned diagnostic features.Fig.…”
Purpose To evaluate the characteristics and racial variations amongst patients with polypoidal choroidal vasculopathy (PCV) in the United States and the United Kingdom.MethodsFundus photos and indocyanine green angiography images were evaluated in a multicenter retrospective study to establish the diagnosis of PCV. Visual acuity (VA) was recorded in ETDRS letter count.ResultsEighty eyes of 71 PCV patients (average age of 69.4 ± 10.4 years) were included in the analysis. Of the total 71 subjects, 46 (65%) were women, 33 (46.5%) were Blacks, 16 (22.5%) were Whites, 19 (26.8%) were Asians and 3 (4.2%) belonged to other races. The Black subgroup had vision gain of 3.5 letters. The White and Asian subgroups had vision loss of 13.1 and 3.5 letters, respectively. There was female predominance in Blacks (67%), Whites (69%), and Asians (58%). PCV was found to be a bilateral disease in 14 patients (20%). There was significant decrease of 7 letters with every decade increase in age (p = 0.005). Final VA was worse in males when compared to females (p = 0.042), and worse in Whites when compared to Blacks (p = 0.005). For every 10 letters worse in initial VA upon diagnosis with PCV, the final VA was worse by 6 letters (p < 0.001). The location of the polypoidal lesion within the macula was associated with significant decrease of 14 letters in BCVA (p = 0.02). The length of follow up was significantly associated with worse visual outcome (p = 0.012). Final VA had no significant correlation with the lens status, or the different treatment modalities.ConclusionsBased on our cohort from tertiary centers in the United States and United Kingdom, PCV is a bilateral disease in one-fifth of patients. It features a variable female predominance based on ethnicity. Increased age, worse vision upon initial presentation, longer follow up and macular location of the polyp were associated with worse visual outcome.Electronic supplementary materialThe online version of this article (doi:10.1186/s40942-017-0060-4) contains supplementary material, which is available to authorized users.
“…Thirty-degree stereo-pair ICGA and FA images of the study eye were taken at 1, 3, 5, 10, and 20 minutes 15 and graded by trained retinal specialists from the Central Reading Center (CRC; Fundus Image Reading Center, National Healthcare Group Eye Institute, Singapore). The diagnosis of PCV was confirmed by the CRC using standardized diagnostic criteria, 13,15,16 which consisted of the presence of early, focal hyperfluorescence on ICGA occurring within the first 5 minutes, together with at least one of the following six criteria: (1) nodular hyperfluorescence on stereoscopic examination, (2) hypofluorescent halo around the nodule, (3) branching vascular network, (4) pulsation of the polyp, (5) orange-red subretinal nodules corresponding to the hyperfluorescence on ICGA, or (6) massive submacular hemorrhage.…”
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.
“…In our centre, we practise achieving reduced-fluence PDT by reducing the duration of laser application. PCV was diagnosed by reading-center certified retinal specialists using dynamic indocyanine green (ICGA) and fluorescein (FA) angiograms (Heidelberg Spectralis, Heidelberg Engineering GmbH, Heidelberg, Germany) using the diagnostic criteria adopted by the EVEREST and EVEREST II studies [3][4][5][21][22][23]. Spectral-domain optical coherence tomography (OCT) (Heidelberg Spectralis, Heidelberg Engineering GmbH, Heidelberg, Germany) was performed in all cases to obtain thickness measurements used in the secondary outcomes described below.…”
Section: Methodsmentioning
confidence: 99%
“…All cases were reviewed by graders from the Fundus Image Reading Center, National Healthcare Group, to confirm the diagnosis of PCV, using standardized diagnostic criteria. PCV was diagnosed based on early subretinal ICGA hyperfluorescence, occurring within the first 6 min, and at least one of the following diagnostic criteria: 1) Nodular appearance of the polyp on stereoscopic viewing, 2) Hypofluorescent halo around the nodule, 3) Abnormal vascular channel(s) supplying the polyps, 4) Pulsatile filling of polyps, 5) Orange sub-retinal nodules corresponding to the hyperfluorescent area on ICGA, 6) Massive submacular haemorrhage [3][4][5][21][22][23]. Cases were classified as macular PCV when more than half of the lesion is within a 6000 μm diameter zone centered over the fovea avascular zone [3][4][5]22].…”
Background: The EVEREST II study reported superior polyp closure rates and visual outcomes using combination standard photodynamic therapy (PDT) with intravitreal ranibizumab in the treatment of polypoidal choroidal vasculopathy (PCV). The optimal PDT protocol remains controversial and it is postulated that less intensive PDT strategies may reduce complications. We aimed to compare the efficacy of reduced and standard-fluence PDT. Methods: Case-control review of 38 consecutive PDT-naïve macular PCV patients who underwent verteporfin PDT using one of two PDT regimens at a tertiary referral centre in an Asian population. Comparison of outcomes between standard-fluence PDT (light dose, 50 J/cm2; dose rate, 600 mW/cm2; wavelength, 689 nm PDT applied to the treatment eye for 83 s) and reduced-fluence PDT (light dose, 25 J/cm2; dose rate, 600 mW/cm2; wavelength, 689 nm PDT applied to the treatment eye for 42 s). Primary outcome measure was best corrected LogMAR visual acuity (VA). Secondary outcome measures included OCT measurements such as central retinal thickness (CRT), height of subfoveal sub-retinal fluid (SRF), central choroid thickness (CCT), mean number of PDT treatments needed, mean number of anti-VEGF injections needed, polyp closure and recurrence rates. Results: Of these 38 eyes of 38 patients, an equal number of eyes (19 in each arm) were treated with standardfluence and reduced-fluence PDT. Mean letter gain at 12 months for the standard-fluence group was 6.0 compared to 4.3 letters for the reduced-fluence group (p = 0.61). Similar results were observed at all time points. There was no statistically significant difference between the retinal and choroidal anatomical OCT outcomes, rates of polyp closure and recurrences between the two PDT regimens. Conclusions: Reduced-fluence PDT was comparable to standard-fluence PDT in the treatment of PCV in terms of visual gains, clinical and anatomical OCT outcomes.
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