Long-Term Management of Polypoidal Choroidal Vasculopathy: A Narrative Review

Area of Science:

• Ophthalmology
• Vascular Biology
• Genetics

Background:

• Polypoidal choroidal vasculopathy (PCV) is a distinct subtype of neovascular age-related macular degeneration (nAMD).
• PCV is characterized by polypoidal lesions and is more prevalent in individuals of Asian ethnicity.
• Under-diagnosis of PCV may occur due to a lack of standardized diagnostic criteria and screening programs.

Purpose of the Study:

• To review current understanding of PCV, including its classification, prevalence, and treatment efficacy.
• To highlight the need for long-term data on anti-vascular endothelial growth factor (VEGF) therapies for PCV.
• To emphasize the necessity of identifying patient subgroups who may not require chronic treatment.

Main Methods:

• Literature review of studies on PCV diagnosis, prevalence, and treatment outcomes.
• Analysis of data on the short-term and long-term efficacy of anti-VEGF monotherapy and combination therapies.
• Examination of reported rates of long-term remission and lesion reactivation in PCV patients.

Main Results:

• PCV is increasingly recognized as a form of type 1 macular neovascularization, a subtype of nAMD.
• Anti-VEGF therapy shows short-term visual acuity benefits, potentially enhanced by combination with photodynamic therapy.
• Long-term efficacy data (≥5 years) for PCV treatments are limited and conflicting, with high rates of lesion reactivation (81.3%) despite initial remission in some patients (21.7-51.5%).

Conclusions:

• Further large-scale, global, randomized, placebo-controlled studies with long-term follow-up are essential for PCV management.
• Real-world evidence is crucial for reliably stratifying PCV patients and guiding treatment cessation in low-risk individuals.
• Identifying subpopulations less likely to require chronic treatment can reduce the socioeconomic burden of long-term PCV management.