Polypoidale chorioidale Vaskulopathie

Zusammenfassung

Bei der polypoidalen chorioidalen Vaskulopathie (PCV) handelt es sich um eine seit fast 30 Jahren bekannte Erkrankung. Die polypoidale chorioidale Vaskulopathie ist durch Veränderungen des hinteren Augenpols charakterisiert: am häufigsten zeigen sich seröse oder serosanguinöse Abhebungen der Neuroretina oder des retinalen Pigmentepithels (RPE) in der Nähe der Papille oder im Makulabereich. Welches das optimale Therapieregime ist, ist derzeitig noch nicht geklärt. Es gibt Studien, die nahelegen, dass insbesondere bei Patienten, die auf eine wiederholte intravitreale Therapie nicht adäquat ansprechen, nicht selten in einer Indocyaningrün-Angiografie eine PCV zu diagnostizieren ist. Therapeutisch kommt alternativ auch eine photodynamische Therapie oder – bei extrafovealer Lokalisation – eine Laserkoagulation der PCV-Läsion in Betracht.

Abstract

Polypoidal choroidal vasculopathy (PCV) is a disease that was first described almost 30 years ago. The disease is characterised by alterations of the posterior pole such as serous or serosanguineous detachments of the retina or the retinal pigment epithelium (RPE) around the optic nerve or in the central macula. The optimal therapeutic regime remains unclear. There are several studies suggesting that patients who do not respond satisfactorily to intravitreal anti-VEGF treatment are suffering from PCV which can be detected by indocyanine green angiography. Alternative therapeutic options consist of photodynamic therapy or laser photocoagulation for extrafoveal lesions.

Schlüsselwörter

polypoidale chorioidale Vaskulopathie - Indocyaningrün-Angiografie - photodynamische Therapie - Differenzialdiagnose der exsudativen altersbedingten Makuladegeneration

Key words

polypoidal choroidal vasculopathy - indocyanine green angiography - photodynamic therapy - differential diagnosis of exsudative age-related macular degeneration

• Literatur

• 1 Imamura Y, Engelbert M, Tomohiro I et al. Polypoidal choroidal vasculopathy: a review. Surv Opthalmol 2010; 55: 501-515
• 2 Stern RM, Zakov ZN, Zeggara H et al. Multiple recurrent serosanguineous retinal pigment epithelial detachments in black women. Am J Ophthalmol 1985; 100: 560-569
• 3 Yannuzzi LA, Sorenson J, Spaide RF et al. Idiopathic polypoidal choroidal vasculopathy (IPCV). Retina 1990; 10: 1-8
• 4 Stanga PE, Lim JI, Hamilton P. Indocyanine green angiography in chorioretinal diseases: indications and interpretation: an evidence-based update. Ophthalmology 2003; 110: 15-21
• 5 Ajuha RM, Stanga PE, Vingerling JR et al. Polypoidal choroidal vasculopathy in exsudative and haemorrhagic pigment epithelium detachments. Br J Ophthalmol 2000; 84: 479-484
• 6 Spaide RF, Yannuzzi LA, Slakter JS et al. Indocyanine green videoangiography of idiopathic choroidal vasculopathy. Retina 1995; 15: 100-110
• 7 Maruko I, Ida T, Saito M et al. Clinical characteristics of exsudative age-related macular degeneration in Japanese patients. Am J Ophthalmol 2007; 144: 15-22
• 8 Sho K, Takahashi K, Yamada H et al. Polypoidal choroidal vasculopathy: incidence, demographic features, and clinical characteristics. Arch Ophthalmol 2003; 121: 1392-1396
• 9 Moorthy RS, Lyon AT, Rabb MF et al. Idiopathic polypoidal choroidal vasculopathy of the macula. Ophthalmology 1998; 105: 1380-1385
• 10 Lafaut BA, Leys AM, Snyers B et al. Polypoidal choroidal vasculopathy in Caucasians. Graefes Arch Clin Exp Ophthalmol 2000; 238: 752-759
• 11 Tsujikawa A, Sasahara M, Otani A et al. Pigment epithelial detachment in polypoidal choroidal vasculopathy. Am J Ophthalmol 2007; 143: 102-111
• 12 Yannuzzi LA, Nogueira FB, Spaide RF et al. Idiopathic polypoidal choroidal vasculopathy: a peripheral lesion. Arch Ophthalmol 1998; 116: 382-383
• 13 Yannuzzi LA, Wong DWK, Sforzolini BS et al. Polypoidal choroidal vasculopathy and neovascular age-related macular degeneration. Arch Ophthalmol 1999; 117: 1503-1510
• 14 Iwama D, Tsujikawa A, Sasahara M et al. Polypoidal choroidal vasculopathy with drusen. Jpn J Ophthalmol 2008; 52: 116-121
• 15 Smith RE, Wise K, Kingsley RM. Idiopathic polypoidal choroidal vasculopathy and sickle cell retinopathy. Am J Ophthalmol 2000; 129: 544-546
• 16 Yannuzzi LA, Freund KB, Goldbaum M et al. Polypoidal choroidal vasculopathy masquerading as central serous chorioretinopathy. Ophthalmology 2000; 107: 767-777
• 17 Tamura H, Tsujikawa A, Otani A et al. Polypoidal choroidal vasculopathy appearing as classic choroidal neovascularization on fluorescein angiography. Br J Ophthalmol 2007; 91: 1152-1159
• 18 Barlett HM, Willoughby B, Mandava N. Idiopathic polypoidal choroidal vasculopathy in a patient with melanocytoma of the optic nerve. Retina 2001; 21: 396-399
• 19 Li H, Wen F, Wu D. Polypoidal choroidal vasculopathy in a patient with circumscribed choroidal hemangioma. Retina 2004; 24: 629-631
• 20 Mauget-Faÿsse M, Cornut PL, Quaranta El-Maftouhi M et al. Polypoidal choroidal vasculopathy in tilted disk syndrome and high myopia with staphyloma. Am J Ophthalmol 2006; 142: 970-975
• 21 Fine HF, Ferrara DC, Ho IV et al. Bilateral choroidal osteomas with polypoidal choroidal vasculopathy. Retin Cases Brief Rep 2008; 2: 15-17
• 22 Uyama M, Wada M, Nagai Y et al. Idiopathic polypoidal choroidal vasculopathy in Japanese patients. Arch Ophthalmol 1999; 117: 1035-1042
• 23 Hirami Y, Tsujikawa A, Otani A et al. Hemorrhagic complications after photodynamic therapy for polypoidal choroidal vasculopathy. Retina 2007; 27: 335-341
• 24 Okubo A, Hirakawa M, Ito M et al. Clinical features of early and late stage polypoidal choroidal vasculopathy characterized by lesion size and disease duration. Graefes Arch Clin Exp Ophthalmol 2008; 246: 491-499
• 25 Okubo A, Ito M, Sameshima M et al. Pulsatile blood flow in the polypoidal choroidal vasculopathy. Ophthalmology 2005; 112: 1436-1441
• 26 Yuzawa M, Mori R, Kawamura A. The origins of polypoidal choroidal vasculopathy. Br J Ophthalmol 2005; 89: 602-607
• 27 Sasahara M, Tsujikawa A, Musashi K et al. Polypoidal choroidal vasculopathy with choroidal vascular hyperpermeability. Am J Ophthalmol 2006; 142: 601-607
• 28 Ojima Y, Tsujikawa A, Otani A et al. Recurrent bleeding after photodynamic therapy in polypoidal choroidal vasculopathy. Am J Ophthalmol 2006; 141: 958-960
• 29 Dewan A, Liu M, Hartman S et al. HTRA1 promoter polymorphism in wet age-related macular degeneration. Science 2006; 314: 989-992
• 30 Lee KY, Vithana EN, Mathur R et al. Association analysis of CFH, C2, BF, and HTRA1 gene polymorphisms in Chinese patients with polypoidal choroidal vasculopathy. Invest Ophthalmol Vis Sci 2008; 49: 2613-2619
• 31 Uyama M. Choroidal neovascularisation, experimental and clinical study. Acta Soc Ophthalmol Jpn 1991; 95: 1145-1180
• 32 Okubo A, Sameshima M, Uemura A et al. Clinicopathological correlation of polypoidal choroidal vasculopathy revealed by ultrastructural study. Br J Ophthalmol 2002; 86: 1093-1098
• 33 Nakashizuka H, Mitsumata M, Okisaka S et al. Clinicopathological findings of polypoidal choroidal vasculopathy. Invest Ophtalmol Vis Sci 2008; 49: 4729-4737
• 34 Rosa jr. RH, Davis JL, Eifrig CW. Clinicopathological correlation of idiopathic polypoidal choroidal vasculopathy. Arch Ophthalmol 2002; 120: 502-508
• 35 Terasaki H, Miyake Y, Suzuki T et al. Polypoidal choroidal vasculopathy treated with macular translocation: clinical pathological correlation. Br J Ophthalmol 2002; 86: 321-327
• 36 Cho M, Barbazetto IA, Freund KB. Refractory neovascular age-related degeneration secondary to polypoidal choroidal vasculopathy. Am J Ophthalmol 2009; 148: 70-78
• 37 Yuzawa M, Mori R, Haruyama M. A study of laser photocoagulation for polypoidal choroidal vasculopathy. Jpn J Ophthalmol 2003; 47: 379-384
• 38 Nishijima K, Takahashi M, Akita J et al. Laser photocoagulation of indocyanine green angiographically identified feeder vessels to idiopathic polypoidal choroidal vasculopathy. Am J Ophthalmol 2004; 137: 770-773
• 39 Okubo A, Ito M, Kamisasanuki T et al. Visual improvement following trans-Tenonʼs retrobulbar triamicinolone acetonide infusion for polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 2005; 243: 837-839
• 40 Silva RM, Figueura J, Cachulo ML et al. Polypoidal choroidal vasculopathy and photodynamic therapy with verteporfin. Graefes Arch Clin Exp Ophthalmol 2005; 243: 973-979
• 41 Spaide RF, Donsoff I, Lam DL et al. Treatment of polypoidal choroidal vasculopathy with photodynamic therapy. Retina 2002; 22: 529-535
• 42 Gomi F, Sawa M, Sakaguchi H et al. Efficacy of intravitreal bevacizumab for choroidal vasculopathy. Br J Ophthalmol 2008; 92: 70-73
• 43 Tong JP, Chan WM, Liu DT et al. Aqueous humor levels of vascular endothelial growth factor and pigment epithelium-derived factor in polypoidal choroidal vasculopathy and choroidal neovascularization. Am J Ophthalmol 2006; 141: 456-462
• 44 Reche-Frutos J, Calvo-Gonzales C, Donate-Lopez J et al. Short-term anatomic effect of ranibizumab for polypoidal choroidal vasculopathy. Eur J Ophthalmol 2008; 18: 645-648
• 45 Tomita K, Tsujikawa A, Yamashiro K et al. Treatment of polypoidal choroidal vasculopathy with photodynamic therapy combined with intravitreal injections of ranibizumab. Am J Ophthalmol 2012; 153: 68-80
• 46 Hlushchuk R, Baum O, Gruber G et al. The synergistic action of a VEGF-receptor tyrosine-kinase inhibitor and a sensitizing PDGF-receptor blocker depends upon the stage of vascular maturation. Microcirculation 2007; 14: 813-825
• 47 Stangos AN, Gandhi JS, Nair-Sahni J et al. Polypoidal choroidal vasculopathy masquerading as neovascular age-related macular degeneration refractory to ranibizumab. Am J Ophthalmol 2010; 150: 666-673