Anti–Vascular Endothelial Growth Factor Resistance in Exudative Macular Degeneration and Polypoidal Choroidal Vasculopathy

To evaluate the prevalence of polypoidal choroidal vasculopathy (PCV) in different ethnic populations and to determine the prevalence of PCV in eyes with exudative age-related macular degeneration (AMD) that is sensitive and resistant to anti–vascular endothelial growth factor (VEGF) therapy. Retrospective chart review. Two hundred fifty-three eyes of 221 patients with exudative AMD. Baseline data were collected on all eyes diagnosed with exudative AMD, which included ethnic data. Polypoidal choroidal vasculopathy was diagnosed using indocyanine green angiography (ICGA) with the scanning laser ophthalmoscope. Exudative AMD eyes were separated into 2 groups: anti-VEGF–resistant eyes with persistent subretinal fluid, subretinal hemorrhage, or macular edema after 4 anti-VEGF injections and anti-VEGF–sensitive eyes defined as eyes without residual disease activity. The prevalence of PCV was determined in each group based on ICGA. Prevalence of PCV in exudative AMD, and in different ethnic populations, and prevalence of anti-VEGF resistance in eyes with and without PCV. Exudative AMD was diagnosed in 253 eyes of 221 patients. Polypoidal choroidal vasculopathy was noted to have a prevalence of 45.1% (114/253 eyes) in the overall population. Polypoidal choroidal vasculopathy was noted in 51.6% (81/157) of eyes with wet AMD in Asians, 31.9% (23/72 eyes) of eyes with wet AMD in white persons, and 28.6% (4/14 eyes) in a small group of Pacific Islanders. Polypoidal choroidal vasculopathy was diagnosed in 50% (60/120 eyes) of eyes in the anti-VEGF–resistant group, which is more prevalent than the 30.2% (29/96 eyes) in the anti-VEGF–sensitive group (P < 0.001). Polypoidal choroidal vasculopathy is more prevalent in Asian patients with exudative AMD, but is more prevalent than generally recognized in white patients. Polypoidal choroidal vasculopathy is more prevalent in anti-VEGF–resistant eyes in both white and Asian patients, which could help to predict therapeutic response.