결절맥락막혈관병증에서 광역학치료의 효과에 대한 다기관 연구

신재필,고형준,권오웅,김시열,김하경,남동흔,남우호,박규형,엄부섭,오재령,유승영,윤일한,윤희성,이성철,이은구,이재흥,이정희,정인영,진희승,허걸,곽형우 대한안과학회 2009 대한안과학회지 Vol.50 No.3

Purpose: To evaluate the efficacy of photodynamic therapy (PDT) with verteporfin for polypoidal choroidal vasculopathy (PCV) in Korean patients. Methods: Clinical data of patients who were treated with PDT for PCV and followed up for more than 6 months were collected from 14 hospitals around the country. The changes in the best corrected visual acuity, angiographic outcome, retinal thickness measured by optical coherence tomography (OCT), and adverse effects of treatment were evaluated. Results: Eighty six patients (86 eyes) were recruited (male: 75.6%, age: 65.9±8.3 years, mean follow-up: 14.8±10.2 months). The mean logMAR visual acuity at baseline was 0.55±0.32 and did not show any statistically significant difference from the final mean logMAR visual acuity (0.53±0.54) (p =0.639). The mean treatment session number of PDT was 2±1.2. Visual acuity stabilized or improved in 70.9% of patients. Visual acuity improved by more than 2 lines in 33 eyes (38.4%) and worsened by more than 2 lines in 21 eyes (24.4%) of patients. Vascular leakage decreased in 62.5% of patients in fluorescein angiography and polypoidal lesions disappeared or were reduced in 57.3% of patients in indocyanine green angiography. There was no systemic adverse effect of PDT, but increased subretinal hemorrhage after PDT occurred in 10 eyes (11.6%). Conclusions: In polypoidal choroidal vasculopathy, photodynamic therapy with verteporfin is safe and effective for preserving visual acuity and reducing vascular leakage and retinal thickness.

결절맥락막혈관병증에서 유리체강내 베바시주맙 주입술의 단기 효과

이민호,안진환,이지은,엄부섭,Min Ho Lee,Jin Hwan An,Ji Eun Lee,Boo Sub Oum 대한안과학회 2009 대한안과학회지 Vol.50 No.1

Purpose: To evaluate the short-term effect of intravitreal bevacizumab (Avastin<sup>Ⓡ) in polypoidal choroidal vasculopathy. Methods: Intravitreal Avastin<sup>Ⓡ was injected into 13 eyes of 13 patients with PCV in this retrospective, interventional case study. The follow-up period lasted over 3 months after therapy. Changes in best-corrected visual acuity (BCVA), foveal height determined by optical coherence tomography, and abnormal vasculature in indocyanine green angiography (ICGA) were evaluated. Results: The mean LogMAR BCVA was 0.82 at baseline, 0.78 at 1 month after treatment, and 0.73 at 3 months after treatment. Visual acuity was stabilized or improved in 13 eyes (100%). The mean foveal height was 288 μm at baseline, 231 μm (p<0.05) at 1 month after treatment, and 196 μm at 3 months after treatment. The polypoidal lesions in ICGA decreased in 4 eyes (31%), although branching vasculature in ICGA was unchanged in 13 eyes (100%). Conclusions: Intravitreal injection of Avastin<sup>Ⓡ may stabilize visual acuity and reduce macular edema due to decreased retinal pigment epithelial detachment and leaking. However, intravitreal injection had a minimal effect in occlusion of the symptomatic polypoidal lesions and no effect in occlusion of the branching vascular network.

결절맥락막혈관병증에서 중심맥락막두께에 따른 애플리버셉트 유리체강내주입술의 효과 분석

이동훈(Dong hun Lee),정성용(Seong yong Jeong),문종원(Jong won Moon),이준엽(Jun yeop Lee),사공민(Min Sa gong) 대한안과학회 2016 대한안과학회지 Vol.57 No.10

목적: 결절맥락막혈관병증 환자에서 중심맥락막두께에 따른 애플리버셉트 유리체강내주입술의 효과 차이를 분석하고자 하였다. 대상과 방법: 본원에서 결절맥락막혈관병증으로 진단 받고 애플리버셉트 유리체강내주입술을 받은 환자 중 6개월 이상 경과 관찰이 가능했던 60명 60안의 의무기록을 후향적으로 분석하였다. 주사 전 측정한 중심맥락막두께에 따라 얇은 군, 중간 군, 두꺼운 군으로 나누고 주사 후 6개월 동안의 최대교정시력, 중심맥락막두께, 중심황반두께 및 최대 망막색소상피박리 높이의 변화와 3개월째 결절 폐쇄율, 6개월째 황반부종 소실률을 비교 분석하였다. 결과: 총 60안 중 얇은 군은 14안(23.3%), 중간 군은 33안(55.0%), 두꺼운 군은 13안(21.7%)이었으며, 주사 전 평균 중심맥락막두께는 각각 178.50 ± 28.42 μm, 287.03 ± 43.58 μm, 379.77 ± 17.09 μm였다. 세 군 간 초진 시 연령, 성비, 최대교정시력, 중심황반두께 및 최대 망막색소상피박리 높이는 유의한 차이가 없었다. 치료 6개월 후 최대교정시력은 얇은 군에서만 유의한 호전을 보였고 (p=0.005) 중간 군과 두꺼운 군에서는 호전은 되었지만 통계적 유의성은 없었다(p=0.063, p=0.692). 중심맥락막두께, 중심황반두께 및 최대 망막색소상피박리 높이는 세 군 모두에서 유의한 감소를 보였다. 중심맥락막두께가 얇을수록 첫 주사 후 3개월째 완전 결절 폐쇄율과 6개월째 황반부종 소실률이 높았다(p=0.013, p=0.004). 결론: 애플리버셉트 유리체강내주입술은 결절맥락막혈관병증의 치료에 있어서 효과적이었고, 중심맥락막두께가 얇을수록 더 좋은 치료 결과를 보였다. <대한안과학회지 2016;57(10):1577-1585> Purpose: To evaluate the effect of intravitreal aflibercept according to subfoveal choroidal thickness in patients with polypoidal choroidal vasculopathy (PCV). Methods: We retrospectively analyzed the medical records of 60 eyes from 60 patients with PCV treated with intravitreal aflibercept. The patients were followed for at least 6 months after the first injection. Using software, subfoveal choroidal thickness was manually measured as the distance from the hyper-reflective line of Bruch’s membrane to the chorioscleral interface on optical coherence tomography. The patients were divided into three groups based on subfoveal choroidal thickness. Visual acuity, subfoveal choroidal thickness, central macular thickness and largest pigment epithelial detachment (PED) height, polyp regression rate, and dry macula rate were evaluated to analyze the anatomical and functional outcomes. Results: Baseline mean subfoveal choroidal thickness were 178.50 ± 28.42 μm in the thin group (14 eyes, 23.3%), 287.03 ± 43.58 μm in the medium group (33 eyes, 55.0%), and 379.77 ± 17.09 μm in the thick group (13 eyes, 21.7%). Baseline age, sex, visual acuity, central macular thickness, and the largest PED height did not differ significantly among the three subgroups. Only the thin group showed significant improvement of visual acuity at 6 months (p = 0.005). Subfoveal choroidal thickness, central macular thickness, and largest PED height were significantly decreased after treatment in all subgroups and did not differ among the subgroups. Compared with the other groups, the thin subfoveal choroidal thickness group showed higher polyp regression rate at 3 months and higher dry macula rate at 6 months (p = 0.013 and p = 0.004, respectively). Conclusions: Intravitreal aflibercept injection was effective for the treatment of PCV, and thin subfoveal choroidal thickness was associated with better anatomical and functional outcomes. J Korean Ophthalmol Soc 2016;57(10):1577-1585

Choroidal Venous Pulsations at an Arterio-venous Crossing in Polypoidal Choroidal Vasculopathy

Akiko Okubo,Munefumi Sameshima,Taiji Sakamoto 대한안과학회 2013 Korean Journal of Ophthalmology Vol.27 No.5

It has been reported that pulsations in abnormal vessels are observed on indocyanine green (ICG)angiography in half of patients with polypoidal choroidal vasculopathy (PCV), although the mechanism of the pulsation is unknown. In this study, we report a case of PCV showing venous pulsations at an arteriovenous (A-V) crossing, and discuss a possible mechanism of polypoidal vessel formation and pulsations in PCV. A 66-year-old female presented with a reddish-orange elevated lesion and serous retinal detachment in the macula of her left eye, and was diagnosed as PCV. She was treated with photodynamic therapy (PDT),and followed-up through routine examinations, including ICG angiography. ICG angiography at presentation showed a branching vascular network and choroidal venules with dye leakage (polypoidal vessels) in the left eye. Pulsations, supposedly of venous origin, were observed at an A-V crossing in the abnormal vessels. Within 3 months after PDT, the polypoidal vessel ceased to leak and the pulsations vanished. The reddish-orange lesion gradually decreased in size with complete disappearance of retinal detachment. This study suggests that an unusual compression at an A-V crossing may make a venule polypoidal, and fluctuations of blood flow and pressure in the venule may cause pulsatile movements of the vessel wall.

Peripapillary Choroidal Thickness Change of Polypoidal Choroidal Vasculopathy after Anti-vascular Endothelial Growth Factor

Kyou Ho Lee,Seo Hee Kim,Ji Min Lee,Eui Chun Kang,Hyoung Jun Koh 대한안과학회 2017 Korean Journal of Ophthalmology Vol.31 No.5

Purpose: To investigate the peripapillary choroidal thickness (PCT) of polypoidal choroidal vasculopathy (PCV) and exudative age-related macular degeneration (AMD) and to evaluate their responses to anti-vascular endothelial growth factor (VEGF). Methods: Thirty eyes with PCV and 25 eyes with exudative AMD who were treatment naïve were included in this study. PCT and subfoveal choroidal thickness were evaluated both before and after intravitreal anti-VEGF. Results: The initial mean PCT of PCV (153.78 ± 56.23 μm) was thicker than that of exudative AMD (88.77 ± 23.11 μm, p < 0.001). Temporal, superior, nasal, and inferior PCTs of PCV were all thicker than those observed in exudative AMD (all p < 0.05). After anti-VEGF, the mean PCT of PCV was significantly reduced (134.17 ± 41.66 μm, p < 0.001), but the same was not true not in exudative AMD (86.87 ± 22.54 μm, p = 0.392). PCT showed a similar tendency in all quadrants. Conclusions: PCV exhibits a thick choroid in the peripapillary region. PCT decreases after anti-VEGF in PCV but not in exudative AMD. In exudative AMD, subfoveal choroidal thickness decreased, but that in the peripapillary region did not.

Diagnosing Polypoidal Choroidal Vasculopathy Using Color Fundus Photography, Optical Coherence Tomography, and Optical Coherence Tomography Angiography

Sejun Park,Junwoo Lee,Jong Beom Park,Eung Suk Kim,Seung-Young Yu,Min Seok Kang,Kiyoung Kim 대한안과학회 2023 Korean Journal of Ophthalmology Vol.37 No.6

Purpose: To compare the diagnostic accuracy of differentiating polypoidal choroidal vasculopathy (PCV) from exudative age-related macular degeneration (AMD), using color fundus photography (CFP), optical coherence tomography (OCT), and swept-source OCT angiography (SS-OCTA) without using indocyanine green angiography (ICGA). Methods: Treatment-naive eyes with exudative AMD that underwent CFP, OCT, SS-OCTA, and ICGA imaging before treatment were identified. Images of each patient were categorized into two sets (set A, CFP + OCT; set B, CFP + SS-OCTA). In set B, both the en face and cross-sectional B scans were analyzed. Each set was reviewed by two graders, and it was determined whether the presumed diagnosis was PCV. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) for the diagnosis of PCV were assessed for each set by comparing diagnoses that included ICGA. The number of polypoidal lesions in each set was calculated and compared to ICGA. Results: A total of 94 eyes from 94 patients with AMD were included in the study, of which 66.0% were male, and the mean age was 71.8 ± 9.0 years. The PCV diagnosis rate using ICGA was 45.7%. The sensitivity was 0.88 for set A and 0.93 for set B, while the specificity was 0.94 for set A and 0.96 for set B. The AUC was 0.90 (95% confidence interval [CI], 0.83–0.97) for set A and 0.96 (95% CI, 0.90–1.00) for set B. Set A detected 1.28 ± 0.91 polypoidal lesions, while set B detected 1.47 ± 1.01; ICGA showed 1.51 ± 0.86. Conclusions: This study highlights that, without using ICGA, both CFP combined with OCT and CFP combined with SS-OCTA demonstrate high sensitivity, specificity, and AUC in diagnosing PCV. It is evident that SS-OCTA contributes to enhancing sensitivity, specificity, and AUC for PCV diagnosis.

Original Articles : Short-term Effectiveness of Intravitreal Bevacizumab vs. Ranibizumab Injections for Patients with Polypoidal Choroidal Vasculopathy

( Han Joo Cho ),( Ji Seon Baek ),( Dong Won Lee ),( Chul Gu Kim ),( Jong Woo Kim ) 대한안과학회 2012 Korean Journal of Ophthalmology Vol.26 No.3

Purpose: To compare the effectiveness of intravitreal injections of bevacizumab and ranibizumab in patients with treatment-naive polypoidal choroidal vasculopathy (PCV). Methods: Records from 106 consecutive patients who received intraviteral bevacizumab (n = 58, 1.25 mg) or ranibizumab (n = 52, 0.5 mg) for treatment of PCV were retrospectively reviewed. After three initial monthly loading injections, injection was performed as needed. The main outcome measures included best-corrected visual acuity (BCVA), foveal central thickness (FCT) as assessed by spectral domain optical coherence tomography, and the changes in polypoidal lesions based on an indocyanine green angiography. Results: The average number of injections was 3.31 ± 1.25 in the bevacizumab group and 3.44 ± 0.92 in the ranibizumab group. Mean logarithm of the minimum angle of resolution of BCVA from baseline to 6 months after injection improved by 0.17 in the bevacizumab group ( p = 0.03) and by 0.19 in the ranibizumab group ( p = 0.01). Average FCT decreased from 322 ± 62.48 μm to 274 ± 40.77 μm in the bevacizumab group ( p = 0.02) and from 338 ± 50.79 μm to 286 ± 36.93 μm in the ranibizumab group ( p = 0.02). Polyp regression rate was 20.7% (12 of 58 eyes) in the bevacizumab group and 21.2% (11 of 52 eyes) in the ranibizumab group. There was no statistically significant difference between groups in BCVA improvement achieved, FCT improvement achieved, and polyp regression rate between groups. Conclusions: Intravitreal injections of bevacizumab and ranibizumab have similar effects in stabilizing of visual acuity, macular edema, and regression of polypoidal complex in PCV eyes over the short term.

Characteristics of Recurrence in Patients with Polypoidal Choroidal Vasculopathy and Myopic Choroidal Neovascularization

Hyung-bin Lim,Kee Sup Park,조영준,김정열 한국망막학회 2019 Journal of Retina Vol.4 No.1

Purpose: To investigate the characteristics of recurrence in patients with polypoidal choroidal vasculopathy (PCV) and myopic choroidal neovascularization (CNV). Methods: In total, 72 eyes from 70 patients with PCV and 51 eyes from 49 patients with myopic CNV were included. PCV and myopic CNV patients were followed up with a pro-re-nata regimen after three monthly injections of anti-vascular endothelial growth factor and underwent spectral-domain optical coherence tomography (SD-OCT). Changes in visual acuity and SD-OCT findings of macular lesions after recurrence were analyzed. Results: We observed a significant difference in recurrence of PCV (59.7%) and myopic CNV (35.3%) during the follow-up period (p = 0.008). With the first recurrence, we observed higher levels of subretinal fluid (SRF) in patients with PCV (93.0%) than myopic CNV (22.2%; p < 0.001). In addition, we observed more subretinal hyperreflective lesions with blurred margins on SD-OCT for patients with myopic CNV (88.9%) than with PCV (18.6%; p < 0.001). Changes in central macular thickness (CMT) following recurrence were greater for patients in the PCV group than in the myopic CNV group (p = 0.024). However, visual acuity was lower in patients with myopic CNV than with PCV (p = 0.001). Conclusions: We observed a greater number of new SRF than subretinal hemorrhage in patients with recurrent PCV, whereas a subretinal hyperreflective lesion with a blurred margin was a major finding in patients with myopic CNV. Myopic CNV patients experienced a greater decrease in visual acuity at recurrence than PCV patients despite minimal changes in CMT.

Peripapillary Choroidal Thickness Change of Polypoidal Choroidal Vasculopathy after Anti-vascular Endothelial Growth Factor

이규호,김서희,이지민,강의천,고형준 대한안과학회 2017 Korean Journal of Ophthalmology Vol.31 No.5

Purpose: To investigate the peripapillary choroidal thickness (PCT) of polypoidal choroidal vasculopathy (PCV)and exudative age-related macular degeneration (AMD) and to evaluate their responses to anti-vascular endothelialgrowth factor (VEGF). Methods: Thirty eyes with PCV and 25 eyes with exudative AMD who were treatment naïve were included inthis study. PCT and subfoveal choroidal thickness were evaluated both before and after intravitreal anti-VEGF. Results: The initial mean PCT of PCV (153.78 ± 56.23 μm) was thicker than that of exudative AMD (88.77 ±23.11 μm, p < 0.001). Temporal, superior, nasal, and inferior PCTs of PCV were all thicker than those observedin exudative AMD (all p < 0.05). After anti-VEGF, the mean PCT of PCV was significantly reduced (134.17 ±41.66 μm, p < 0.001), but the same was not true not in exudative AMD (86.87 ± 22.54 μm, p = 0.392). PCTshowed a similar tendency in all quadrants. Conclusions: PCV exhibits a thick choroid in the peripapillary region. PCT decreases after anti-VEGF in PCVbut not in exudative AMD. In exudative AMD, subfoveal choroidal thickness decreased, but that in the peripapillaryregion did not.

망막하출혈이 발생한 결절맥락막혈관병증의 특징

최우곤,조영욱,장지혜 대한안과학회 2015 대한안과학회지 Vol.56 No.7

목적: 인도사이아닌그린혈관조영술(indocyanine green angiography, ICGA)과 스펙트럼영역 빛간섭단층촬영기(spectral domainoptical coherence tomography, SD-OCT)를 이용하여 망막하출혈이 동반된 결절맥락막혈관병증(polypoidal choroidal vasculopathy,PCV)의 특징 및 위험인자를 알아보고자 하였다. 대상과 방법: 2010년 1월부터 2013년 10월까지 본원에서 PCV로 진단 받은 환자 중에서 ICGA 검사결과가 포함된 환자 43명, 45안을 선별 후, 망막하출혈을 동반한 16명 17안의 환자를 대상군으로 하였으며, 같은 기간 동안 망막하출혈을 보이지 않았던 27명 28안을 대조군으로 하여 의무기록을 후향적으로 분석하였다. ICGA와 SD-OCT를 이용하여 PCV에서 결절(polyp)의 개수, 형태, 위치, 크기와 망막색소상피박리 및 장액성망막박리의 바닥길이와 높이를 측정하였으며, 전신 질환 및 항혈전제 복용 유무를 후향적으로 조사하여 두 군 간에 비교하였다. 결과: 망막하출혈군과 대조군을 ICGA로 측정 후 비교한 결과, 결절의 크기에 따른 두 군 간에 유의한 차이가 있었으며(p=0.006),결절이 클수록 망막출혈의 범위, 망막색소상피박리의 높이 및 장액성망막박리의 바닥길이와 높이가 증가하는 양상을 보였다 (p<0.05). 하지만 전신질환 및 항혈전제 복용 유무와 관련해서는 두 군 간의 유의한 차이는 없었다(p>0.05). 결론: PCV 환자에서 망막하출혈이 동반된 군이 대조군보다 결절의 크기가 크게 관찰되었으며, 이를 바탕으로 PCV 환자에서 결절이 큰 경우는 자연경과상 발생하는 망막하출혈의 위험인자로서 좀 더 주의 깊은 추적관찰이 필요할 것으로 생각된다. Purpose: To evaluate the clinical features and risk factors of hemorrhagic complications in polypoidal choroidal vasculopathy(PCV) using spectral domain-optical coherence tomography (SD-OCT) and indocyanine green angiography (ICGA). Methods: We respectively reviewed the data from 43 patients (45 eyes) diagnosed with PCV who received ICGA between January 2010 and October 2013. The patients were divided into 2 groups: 16 patients (17 eyes) with subretinal hemorrhage (subretinal hemorrhagic PCV group) and 27 patients (28 eyes) without subretinal hemorrhage (control group). Based on the ICGA and SD-OCT findings, the number, morphology, location, size of polyps, pigment epithelial detachment (PED), and serous retinal detachment (SRD) were measured and compared between the 2 groups. We also analyzed systemic diseases and history of antithrombotic agents associated with subretinal hemorrhage in PCV. Results: The size of polyps measured by ICGA was significantly different between the 2 groups (p = 0.006). As the size of polyps increased, the size of subretinal hemorrhage, height of PED, base diameter and height of SRD increased (p < 0.05). No statistical correlation with systemic diseases and antithrombotic agents was observed (p > 0.05). Conclusions: The patients in the subretinal hemorrhagic PCV group had larger-sized polyps than the patients in the control group. This result suggests that eyes with larger-sized polyps are at risk for hemorrhagic complications and require more careful follow-up and observation in PCV treatment-naïve patients.