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Clinical features, management and visual outcome of polypoidal choroidal vasculopathy in Indian patients.

Anantharaman G, Ramkumar G, Gopalakrishnan M, Rajput A - Indian J Ophthalmol (2010 Sep-Oct)

Bottom Line: Demographic data, clinical features and results of treatment were analyzed.Subgroup analysis of visual outcome following various modalities of treatment showed that the results of PDT (P < 0.001) and thermal laser (P < 0.001) were statistically significant.Thermal laser and PDT were safe and effective.

View Article: PubMed Central - PubMed

Affiliation: Department of Vitreoretinal Services, Giridhar Eye Institute, Cochin, India.

ABSTRACT

Aims: To present the clinical, indocyanine green angiography (ICGA) features and results of treatment for polypoidal choroidal vasculopathy (PCV) in Indian patients by a retrospective chart review.

Materials and methods: Forty five patients with PCV underwent complete ocular examination, fluorescein angiography (FFA) and ICGA. Treatment was advised for patients with macular involvement and progressive loss of visual acuity. Demographic data, clinical features and results of treatment were analyzed.

Results: Mean age at presentation was 61.06 years. Mean follow up was 18 months. The disease was more prevalent in males. Forty three patients had unilateral disease. The most common location of polyps in ICGA was subfoveal (42.5%). Exudative form was seen in 34 of the 47 eyes and the remaining 13 eyes had a hemorrhagic presentation. Thirty four eyes underwent treatment which included thermal laser (n = 11), photodynamic therapy (PDT) (n = 11) and transpupillary thermo therapy (TTT) (n = 12). Statistical analysis was done using the Chi-square test. Subgroup analysis of visual outcome following various modalities of treatment showed that the results of PDT (P < 0.001) and thermal laser (P < 0.001) were statistically significant.

Conclusions: PCV is an important differential diagnosis in patients presenting with serosanginous maculopathy and submacular hemorrhage. The disease was more prevalent in males and was unilateral in the Indian population. Timely intervention in cases with symptomatic polyps could achieve stabilization of visual acuity. Thermal laser and PDT were safe and effective.

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A 68-year-old male presented after receiving three injections of intravitreal bevacizumab elsewhere with no response and further decrease in vision. (A) Initial visit shows intraretinal lipid deposits involving the fovea. Visual acuity 20/80. (B and C) Early and late ICGA shows saccular dilatation extrafoveal in location (arrow). (D) Seven months following laser, clinical photograph shows significant decrease in intraretinal lipid deposits and visual acuity improved to 20/30. (E and F) Post-treatment ICGA shows regression of the polyps
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Figure 0004: A 68-year-old male presented after receiving three injections of intravitreal bevacizumab elsewhere with no response and further decrease in vision. (A) Initial visit shows intraretinal lipid deposits involving the fovea. Visual acuity 20/80. (B and C) Early and late ICGA shows saccular dilatation extrafoveal in location (arrow). (D) Seven months following laser, clinical photograph shows significant decrease in intraretinal lipid deposits and visual acuity improved to 20/30. (E and F) Post-treatment ICGA shows regression of the polyps

Mentions: Table 2 gives the details of the 11 patients treated with thermal laser. Mean follow up was 10.36 months (average 3–36 months). Visual acuity improved in 10 eyes and worsened in 1 eye. There was a significant improvement in the clinical picture following treatment and post-treatment. ICGA showed closure of polyps in all the eyes. A representative case is illustrated in Fig. 4. Mean pretreatment visual acuity improved from 1.18 logMAR units to a post-treatment visual acuity of 0.28 logMAR units, a difference that was significant (P < 0.001). The treatment was safe with no adverse events. Recurrence was noticed in one eye, 6 months following treatment, and this was retreated with thermal laser. Intravitreal bevacizumab was combined with thermal laser in two eyes with significant exudation.


Clinical features, management and visual outcome of polypoidal choroidal vasculopathy in Indian patients.

Anantharaman G, Ramkumar G, Gopalakrishnan M, Rajput A - Indian J Ophthalmol (2010 Sep-Oct)

A 68-year-old male presented after receiving three injections of intravitreal bevacizumab elsewhere with no response and further decrease in vision. (A) Initial visit shows intraretinal lipid deposits involving the fovea. Visual acuity 20/80. (B and C) Early and late ICGA shows saccular dilatation extrafoveal in location (arrow). (D) Seven months following laser, clinical photograph shows significant decrease in intraretinal lipid deposits and visual acuity improved to 20/30. (E and F) Post-treatment ICGA shows regression of the polyps
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2992915&req=5

Figure 0004: A 68-year-old male presented after receiving three injections of intravitreal bevacizumab elsewhere with no response and further decrease in vision. (A) Initial visit shows intraretinal lipid deposits involving the fovea. Visual acuity 20/80. (B and C) Early and late ICGA shows saccular dilatation extrafoveal in location (arrow). (D) Seven months following laser, clinical photograph shows significant decrease in intraretinal lipid deposits and visual acuity improved to 20/30. (E and F) Post-treatment ICGA shows regression of the polyps
Mentions: Table 2 gives the details of the 11 patients treated with thermal laser. Mean follow up was 10.36 months (average 3–36 months). Visual acuity improved in 10 eyes and worsened in 1 eye. There was a significant improvement in the clinical picture following treatment and post-treatment. ICGA showed closure of polyps in all the eyes. A representative case is illustrated in Fig. 4. Mean pretreatment visual acuity improved from 1.18 logMAR units to a post-treatment visual acuity of 0.28 logMAR units, a difference that was significant (P < 0.001). The treatment was safe with no adverse events. Recurrence was noticed in one eye, 6 months following treatment, and this was retreated with thermal laser. Intravitreal bevacizumab was combined with thermal laser in two eyes with significant exudation.

Bottom Line: Demographic data, clinical features and results of treatment were analyzed.Subgroup analysis of visual outcome following various modalities of treatment showed that the results of PDT (P < 0.001) and thermal laser (P < 0.001) were statistically significant.Thermal laser and PDT were safe and effective.

View Article: PubMed Central - PubMed

Affiliation: Department of Vitreoretinal Services, Giridhar Eye Institute, Cochin, India.

ABSTRACT

Aims: To present the clinical, indocyanine green angiography (ICGA) features and results of treatment for polypoidal choroidal vasculopathy (PCV) in Indian patients by a retrospective chart review.

Materials and methods: Forty five patients with PCV underwent complete ocular examination, fluorescein angiography (FFA) and ICGA. Treatment was advised for patients with macular involvement and progressive loss of visual acuity. Demographic data, clinical features and results of treatment were analyzed.

Results: Mean age at presentation was 61.06 years. Mean follow up was 18 months. The disease was more prevalent in males. Forty three patients had unilateral disease. The most common location of polyps in ICGA was subfoveal (42.5%). Exudative form was seen in 34 of the 47 eyes and the remaining 13 eyes had a hemorrhagic presentation. Thirty four eyes underwent treatment which included thermal laser (n = 11), photodynamic therapy (PDT) (n = 11) and transpupillary thermo therapy (TTT) (n = 12). Statistical analysis was done using the Chi-square test. Subgroup analysis of visual outcome following various modalities of treatment showed that the results of PDT (P < 0.001) and thermal laser (P < 0.001) were statistically significant.

Conclusions: PCV is an important differential diagnosis in patients presenting with serosanginous maculopathy and submacular hemorrhage. The disease was more prevalent in males and was unilateral in the Indian population. Timely intervention in cases with symptomatic polyps could achieve stabilization of visual acuity. Thermal laser and PDT were safe and effective.

Show MeSH
Related in: MedlinePlus