THE ROLE OF AFLIBERCEPT IN THE  TREATMENT OF A PATIENT WITH  POLYPOIDAL CHOROIDAL  VASCULOPATHY - CASE REPORT

Natasa Trpevska Sekerinov; Jana Nivichka  Kjaeva; Stefan Pandilov; Emilija Gjoshevska Dashtevska; Andrijana Petrusevska

Natasa Trpevska Sekerinov University Clinic for Eye Diseases, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
Jana Nivichka Kjaeva University Clinic for Eye Diseases, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
Stefan Pandilov University Clinic for Eye Diseases, Skopje, Republic of North Macedonia
Emilija Gjoshevska Dashtevska University Clinic for Eye Diseases, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
Andrijana Petrusevska University Clinic for Eye Diseases, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia

Abstract

To present a patient with polypoidal choroidal vasculopathy, an entity often overlooked and misdiagnosed in daily clinical practice. A 73-year-old patient with reduced visual acuity in the left eye was evaluated with a complete ophthalmological examination, fundus photography, optical coherence tomography of the posterior segment of the eye, and optical coherence tomography with angiography and a diagnosis of polypoidal choroidal vasculopathy with development of a type 1 choroidal neovascular network (aneurysmal-polypoidal network) was made. The changes shown on OCT referred to the presence of subretinal fluid, PED in the shape of the letter M, the presence of a "double layer sign" from the developed neovascular network in the form of a renal glomerulus. After application of an anti-VEGF preparation (Aflibercept) for a period of six months (five applied doses, three consecutive, and two every two months) there was regression of the lesion and improvement of visual acuity from 0.5 to 0.9 according to the Snellen optotype. The characteristic changes of OCT and OCT-A, as well as the course of the disease corresponded with the literature data that we consulted during the evaluation of this case, thus the diagnosis of polypoidal choroidal vasculopathy was confirmed. Timely recognition of this not so rare entity is of great importance for appropriate management and treatment of the affected patient.

Keywords: polypoidal choroidal vasculopathy, subretinal fluid, choroidal neovascular membrane, aflibercept

References

1.Kleiner RC, Brucker AJ, Johnston RL. The posterior uveal bleeding syndrome. Retina. 1990;10(1):9-17. PMID: 2343198.
2.Yannuzi LA. Presented at the Macula Society Meeting. Miami, Fla: 1982. Feb 5, Idiopathic polypoidal choroidal vasculopathy.
3.Borooah S, Sim PY, Phatak S, Moraes G, Wu CY, Cheung CMG, Pal B, Bujarborua D. Pachychoroid spectrum disease. Acta Ophthalmol. 2021 Sep;99(6):e806-e822. doi: 10.1111/aos.14683. Epub 2020 Nov 30. PMID: 33258304.
4.Kumar A, Kumawat D, Sundar M D, Gagrani M, Gupta B, Roop P, Hasan N, Sharma A, Chawla R. Polypoidal choroidal vasculopathy: a comprehensive clinical update. Ther Adv Ophthalmol. 2019 Feb 27;11:2515841419831152. doi: 10.1177/2515841419831152. PMID: 30834360; PMCID: PMC6393826.
5.Yannuzzi LA, Wong DW, Sforzolini BS, Goldbaum M, Tang KC, Spaide RF, Freund KB, Slakter JS, Guyer DR, Sorenson JA, Fisher Y, Maberley D, Orlock DA. Polypoidal choroidal vasculopathy and neovascularized age-related macular degeneration. Arch Ophthalmol. 1999 Nov;117(11):1503-10. doi: 10.1001/archopht.117.11.1503. PMID: 10565519.
6.Byeon SH, Lee SC, Oh HS, Kim SS, Koh HJ, Kwon OW. Incidence and clinical patterns of polypoidal choroidal vasculopathy in Korean patients. Jpn J Ophthalmol. 2008 Jan-Feb;52(1):57-62. doi: 10.1007/s10384-007-0498-2. Epub 2008 Mar 28. PMID: 18369702.
7.Sakurada Y, Yoneyama S, Imasawa M, Iijima H. Systemic risk factors associated with polypoidal choroidal vasculopathy and neovascular age-related macular degeneration. Retina. 2013 Apr;33(4):841-5. doi: 10.1097/IAE.0b013e31826ffe9d. PMID: 23400077.
8.Ma D, Kumar M, Khetan V, Sen P, Bhende M, Chen S, Yu TTL, Lee S, Navajas EV, Matsubara JA, Ju MJ, Sarunic MV, Raman R, Beg MF. Clinical explainable differential diagnosis of polypoidal choroidal vasculopathy and age-related macular degeneration using deep learning. Comput Biol Med. 2022 Feb 14;143:105319. doi: 10.1016/j.compbiomed.2022.105319. Epub ahead of print. PMID: 35220077.
9.Anantharaman G, Sheth J, Bhende M, Narayanan R, Natarajan S, Rajendran A, Manayath G, Sen P, Biswas R, Banker A, Gupta C. Polypoidal choroidal vasculopathy: Pearls in diagnosis and management. Indian J Ophthalmol. 2018 Jul;66(7):896-908. doi: 10.4103/ijo.IJO_1136_17. PMID: 29941728; PMCID: PMC6032720.
10.Tan CS, Ngo WK, Chen JP, Tan NW, Lim TH; EVEREST Study Group. EVEREST study report 2: imaging and grading protocol, and baseline characteristics of a randomised controlled trial of polypoidal choroidal vasculopathy. Br J Ophthalmol. 2015 May;99(5):624-8. doi: 10.1136/bjophthalmol-2014-305674. Epub 2015 Mar 10. PMID: 25758601; PMCID: PMC4413842.
11.Kawamura A, Yuzawa M, Mori R, Haruyama M, Tanaka K. Indocyanine green angiographic and optical coherence tomographic findings support classification of polypoidal choroidal vasculopathy into two types. Acta Ophthalmol. 2013 Sep;91(6):e474-81. doi: 10.1111/aos.12110. Epub 2013 Jul 15. PMID: 23848133.
12.Gomi F, Sawa M, Mitarai K, Tsujikawa M, Tano Y. Angiographic lesion of polypoidal choroidal vasculopathy on indocyanine green and fluorescein angiography. Graefes Arch Clin Exp Ophthalmol. 2007 Oct;245(10):1421-7. doi: 10.1007/s00417-007-0564-y. Epub 2007 Mar 9. PMID: 17347808.
13.De Salvo G, Vaz-Pereira S, Keane PA, Tufail A, Liew G. Sensitivity and specificity of spectral-domain optical coherence tomography in detecting idiopathic polypoidal choroidal vasculopathy. Am J Ophthalmol. 2014 Dec;158(6):1228-1238.e1. doi: 10.1016/j.ajo.2014.08.025. Epub 2014 Aug 22. PMID: 25152500.
14.Wang M, Zhou Y, Gao SS, Liu W, Huang Y, Huang D, Jia Y. Evaluating Polypoidal Choroidal Vasculopathy With Optical Coherence Tomography Angiography. Invest Ophthalmol Vis Sci. 2016 Jul 1;57(9):OCT526-32. doi: 10.1167/iovs.15-18955. PMID: 27472276; PMCID: PMC4970807.
15.Oishi A, Miyamoto N, Mandai M, Honda S, Matsuoka T, Oh H, Kita M, Nagai T, Bessho N, Uenishi M, Kurimoto Y, Negi A. LAPTOP study: a 24-month trial of verteporfin versus ranibizumab for polypoidal choroidal vasculopathy. Ophthalmology. 2014 May;121(5):1151-2. doi: 10.1016/j.ophtha.2013.12.037. Epub 2014 Jan 29. PMID: 24484991.
16.Lee WK, Iida T, Ogura Y, Chen SJ, Wong TY, Mitchell P, Cheung GCM, Zhang Z, Leal S, Ishibashi T; PLANET Investigators. Efficacy and Safety of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy in the PLANET Study: A Randomized Clinical Trial. JAMA Ophthalmol. 2018 Jul 1;136(7):786-793. doi: 10.1001/jamaophthalmol.2018.1804. Erratum in: JAMA Ophthalmol. 2018 Jul 1;136(7):840. PMID: 29801063; PMCID: PMC6136040.
17 Kokame GT, Lai JC, Wee R, Yanagihara R, Shantha JG, Ayabe J, Hirai K. Prospective clinical trial of Intravitreal aflibercept treatment for PolypoIdal choroidal vasculopathy with hemorrhage or exudation (EPIC study): 6 month results. BMC Ophthalmol. 2016 Jul 27;16:127. doi: 10.1186/s12886-016-0305-2. PMID: 27465105; PMCID: PMC4964097.