Polypoidal Choroidal Vasculopathy: An Update on Diagnosis and Treatment

Abstract

Polypoidal choroidal vasculopathy (PCV) is a vascular disease of the choroid that leads to hemorrhagic and exudative macular degeneration. It may cause significant vision loss and thus affect the quality-of-life and psychological well-being. Non-invasive, non-ICGA-based OCT criteria have shown reliable results to plan adjunct photodynamic therapy (PDT) treatment, with the complete and consistent coverage of polypoidal lesions (PL) and branching neovascular network (BNN). The safety and efficacy of anti-vascular endothelial growth factor (anti-VEGF) monotherapy and its combination with verteporfin PDT have been established. However, treatment is still challenging due to frequent follow-ups, non-availability of PDT, and need for multiple anti-VEGF injection visits that increase the treatment burden and lead to patients being lost to follow-up. Effective treatments that prolong intervals between injections while maintaining vision and anatomical gains remain a critical unmet need. Longer acting molecules, like brolucizumab, have shown non-inferiority in BCVA gains and superior anatomical outcomes compared to other anti-VEGF agents. Newer therapies in the pipeline to enhance the efficacy and longevity of treatment include Faricimab and a port delivery system (PDS). This review summarizes the most recent diagnostic and treatment approaches in PCV to offer better treatment avenues.

Keywords:

• polypoidal lesions
• branching neovascular network
• photodynamic therapy
• best-corrected visual acuity
• anti-vascular endothelial growth factor (anti-VEGF) agents
• brolucizumab

Acknowledgments

The authors would like to thank Dr Shweta Varshney, IQVIA, for her writing and editing support.

Disclosure

Vineeth Salloju and Priyanka Dhar are employees of Novartis Healthcare Private Limited, India. The authors report no other conflicts of interest in this work.