Long-Term Management of Polypoidal Choroidal Vasculopathy: A Narrative Review

Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular age-related macular degeneration (nAMD), characterised by polypoidal lesions. Prevalence data indicate that PCV is more common in people of Asian ethnicity, although it also occurs in non-Asian individuals. However, because of a lack of globally agreed diagnostic criteria and routine screening programmes, PCV is likely to be under-diagnosed in some populations. Recent consensus suggests that PCV is a form of type 1 macular neovascularisation and should be classified as a subtype of nAMD. Anti-vascular endothelial growth factor (VEGF) monotherapy has demonstrated short-term efficacy in terms of visual acuity in PCV, and outcomes may be further improved by combining anti-VEGF therapy with photodynamic therapy. However, data on the long-term (≥ 5 years) efficacy of these treatments are limited and often conflicting. Although some people with PCV can achieve long-term remission following initial treatment (21.7-51.5%), eventual lesion reactivation is reported for approximately four-fifths of patients (81.3%). The socioeconomic impact of long-term PCV management could be reduced by identifying and characterising the subpopulations least likely to require chronic treatment. Large, global, randomised, placebo-controlled studies with long-term follow-up periods are needed in addition to real-world evidence to allow clinicians to reliably stratify people with PCV and support the stopping of anti-VEGF therapy in people at low risk of disease reactivation.