Polypoidal Choroidal Vasculopathy: Updates on Risk Factors, Diagnosis, and Treatments

Area of Science:

• Ophthalmology
• Retinal Diseases
• Vascular Biology

Background:

• Polypoidal choroidal vasculopathy (PCV) is a significant cause of vision impairment.
• Emerging evidence links systemic factors (male gender, smoking, C-reactive protein) and pachydrusen to PCV risk.
• Diagnostic approaches are shifting towards noninvasive multimodal retinal imaging, reducing reliance on indocyanine green angiography.

Purpose of the Study:

• To review recent advances in the understanding, diagnosis, and treatment of PCV.
• To highlight the role of systemic factors and pachydrusen in PCV development.
• To discuss the application of artificial intelligence and novel therapeutic strategies in managing PCV.

Main Methods:

• Review of recent large-scale population-based studies and systematic reviews on PCV.
• Analysis of studies focusing on noninvasive multimodal retinal imaging for PCV diagnosis.
• Evaluation of research on deep learning models for PCV detection.
• Assessment of clinical trials and evidence for current and emerging PCV treatments.

Main Results:

• Systemic factors (male gender, smoking) and plasma C-reactive protein are associated with PCV.
• Pachydrusen show a growing association with PCV risk.
• Deep learning models demonstrate high performance in detecting PCV using color retinal images and optical coherence tomography.
• Current treatments include combination therapy (verteporfin photodynamic therapy + anti-VEGF) or anti-VEGF monotherapy; new anti-VEGF agents show promise.

Conclusions:

• PCV is influenced by systemic factors and potentially pachydrusen.
• Noninvasive imaging and AI are advancing PCV diagnosis.
• Anti-VEGF therapies, potentially combined with other treatments, are mainstays, with new agents offering improved durability.
• Long-term follow-up is crucial for detecting recurrence, especially with incomplete lesion closure.