Microrips of the Retinal Pigment Epithelium in Polypoidal Choroidal Vasculopathy

Musashi, Kunihiro; Tsujikawa, Akitaka; Hirami, Yasuhiko; Otani, Atsushi; Yodoi, Yuko; Tamura, Hiroshi; Yoshimura, Nagahisa

doi:10.1016/j.ajo.2006.12.024

Cited by 25 publications

(12 citation statements)

References 7 publications

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“…hyperplasia, atrophy) are frequently found overlying and around the lesions [11,13]. Microrips of the RPE and RPE tears could be found at the margins of the PEDs [46,47]. In some cases, multiple PEDs may span widely at the posterior pole of the retina, or more than 2 independent lesions could be found (i.e.…”

Section: Clinical Manifestationmentioning

confidence: 99%

Polypoidal Choroidal Vasculopathy: Clinical Features and Genetic Predisposition

2013

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Polypoidal choroidal vasculopathy (PCV) is currently recognized as a phenotype of age-related macular degeneration (AMD). PCV is believed to be a type of choroidal neovascularization, although some cases of PCV show a distinct vascular abnormality of the choroidal vessels. PCV often shows several unique clinical manifestations which are apparently different from typical neovascular AMD (tAMD). In addition, the natural course and response to treatment are often different between tAMD and PCV. Moreover, recent genetic studies suggested a possible difference in the genetic susceptibility to disease between tAMD and PCV, as well as the existence of heterogeneity among PCV cases. In viewing the accumulation of knowledge about PCV, we have summarized the recent literature regarding PCV in this review article to improve the understanding of this clinical entity including possible susceptibility genes. We will also discuss the optimal treatment strategies for PCV in accordance with the results of recent clinical and genetic studies.

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Section: Clinical Manifestationmentioning

confidence: 99%

Polypoidal Choroidal Vasculopathy: Clinical Features and Genetic Predisposition

2013

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“…While PDT is effective in closing polyps [ 18 ], it is not without risk. Studies have reported complications following PDT, including subretinal, vitreous, and suprachoroidal hemorrhage, as well as tears and rips of the retinal pigment epithelium [ 28 – 30 ]. PDT is also believed to cause choroidal ischemia and thrombosis, with resultant up-regulation of VEGF production [ 31 – 34 ].…”

Section: Discussionmentioning

confidence: 99%

EVEREST study report 3: diagnostic challenges of polypoidal choroidal vasculopathy. Lessons learnt from screening failures in the EVEREST study

Tan

Ngo

Lim

et al. 2016

Graefes Arch Clin Exp Ophthalmol

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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 sub-retinal 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) pulsation of polyp(s) on dynamic ICGA, (5) orange sub-retinal nodules on colour fundus photography, or (6) massive sub-macular haemorrhage (≥4 disc areas in size). Additional detailed image grading was performed with stereo-imaging and dynamic early-phase ICGA.ResultsOf the 95 screened PCV cases, 34 were excluded: (1) cases not suitable for recruitment as per the study protocol (n = 14), (2) equivocal lesions on ICGA characterised by small hyperfluorescent dots (n = 9), and (3) cases that were definitely not PCV (non-PCV, n = 11), identified by definitive diagnoses which included one case each of micro-aneurysm, retinal angiomatous proliferation, retino-choroidal anastomosis, small type-2 choroidal neovascularisation, retinal pigment epithelial (RPE) window defect and disciform scar; two cases of lesions where the choroidal vessel changed its course; and three cases of late-onset RPE staining.ConclusionsStandardised image grading techniques used in EVEREST study enabled effective differentiation of non-PCV from actual PCV.Electronic supplementary materialThe online version of this article (doi:10.1007/s00417-016-3333-y) contains supplementary material, which is available to authorized users.

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“…Post-PDT SRH, massive suprachoroidal hemorrhage, RPE tears, and microrips at the margin of the PED are the reported complications of PDT for PCV. [146147148149] Hirami et al . found SRH in 28 (30.8%) of 91 eyes post-PDT, developing within 1 month of treatment and vitreous hemorrhage in 6 (6.6%) eyes.…”

Section: Managementmentioning

confidence: 99%

Polypoidal choroidal vasculopathy: An update on current management and review of literature

Palkar

Khetan

2019

Taiwan J Ophthalmol

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Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular age-related macular degeneration (nAMD), commonly seen in the Asian population. It is dissimilar in epidemiology, genetic heterogeneity, pathogenesis, natural history, and response to treatment in comparison to nAMD. Confocal scanning laser ophthalmoscopy-based simultaneous fluorescein angiography and indocyanine green angiography, spectral-domain optical coherence tomography (OCT) with enhanced depth imaging, swept-source OCT, and OCT angiography have improved the ability to detect PCV, understand its pathology, and monitor treatment response. A plethora of literature has discussed the efficacy of photodynamic therapy, anti-vascular endothelial growth factor (VEGF) monotherapy, and combination of both, but only a few studies with higher level of evidence and limited follow-up duration are available. This review discusses the understanding of PCV with respect to epidemiology, pathogenesis, clinical features, natural history, imaging techniques, and various treatment options. Recent clinical trials (EVEREST-II and PLANET study) have emphasized that either anti-VEGF monotherapy or combination treatment is equally capable to strike a balance between polyp regression and stabilization of visual acuity. The recurrent nature of the disease, the development of macular atrophy, and the long-term poor visual prognosis despite treatment are concerns that open avenues for further research.

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Microrips of the Retinal Pigment Epithelium in Polypoidal Choroidal Vasculopathy

Cited by 25 publications

References 7 publications

Polypoidal Choroidal Vasculopathy: Clinical Features and Genetic Predisposition

Polypoidal Choroidal Vasculopathy: Clinical Features and Genetic Predisposition

EVEREST study report 3: diagnostic challenges of polypoidal choroidal vasculopathy. Lessons learnt from screening failures in the EVEREST study

Polypoidal choroidal vasculopathy: An update on current management and review of literature

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