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

There have been recent advancements in basic research and clinical studies in polypoidal choroidal vasculopathy (PCV). Some systemic factors, such as male gender and smoking, were found to be associated with PCV in a recently published, large-scale, population-based study, whereas a systemic biomarker, plasma C-reactive protein, was found to be associated with PCV in a recent systematic review. Growing data point to association between pachydrusen, recently proposed extracellular deposits associated with the thick choroid, and the risk of development of PCV. Many recent studies on diagnosis of PCV have focused on applying criteria from noninvasive multimodal retinal imaging without requirement of indocyanine green angiography. There have been attempts to develop deep learning models, a recent subset of artificial intelligence, for detecting PCV from different types of retinal imaging modality. Some of these deep learning models were found to have high performance when they were trained and tested on color retinal images with corresponded images from optical coherence tomography. The treatment of PCV can be combination therapy using verteporfin photodynamic therapy and anti-vascular endothelial growth factor (VEGF) or anti-VEGF monotherapy in the treat-and-extend regimen. New anti-VEGF agents seem to provide better treatment durability with similar efficacy, compared with existing anti-VEGF agents. It is not known if they can induce better closure of polypoidal lesions; for this purpose, combination therapy is still a mainstay. Recent evidence supports long-term follow-up of patients with PCV after treatment for early detection of recurrence, particularly in patients with incomplete closure of polypoidal lesions.