2. Systemic Steroids As An Aid To The
Management Of Idiopathic
Polypoidal Choroidal Vasculopathy
(IPCV): A Descriptive Analysis
Aditya Sudhalkar ,Divya Balakrishnan , Subhadra Jalali
Raja Narayanan
3. To determine the role of systemic steroids in improving visual acuity,
preventing recurrence and hastening pigment epithelial detachment resolution
in IPCV patients.
4. • IPCV is characterized by polypoidal dilatations of the choroidal vasculature in
the foveal or extrafoveal region, which results in hemorrhagic or exudative
pigment epithelial detachments.
• In the natural history of PCV, half of the patients had persistent leakage or
repeated bleeding and a poor visual outcome.
• Sho et al. also reported severe visual loss in 35% of eyes with IPCV.
• The EVEREST trial showed that photodynamic therapy, alone or combined with
anti-VEGF therapy was better than anti- VEGF monotherapy alone
• The EVEREST study looked at the role of combination therapy with verteporfin based photodynamic
treatment with or without intravitreal ranibizumab vs monotherapy with intravitreal ranibizumab
• There is a lack of evidence regarding the most appropriate therapy or a
combination there of for treatment of polyps.
5. • Retrospective computer assisted comparative case series of consecutive patients with
documented IPCV who did and did not receive systemic steroids as part of their
treatment regimen between 2007 and 2012.
• Patients who had systemic con-traindication to steroid therapy were excluded from the
steroid arm.
• Data collected included demographics, the best corrected visual acuity, details of the
ocular and systemic exam, the treatment offered, the follow-up period and the final visual
and anatomic outcomes.
• All patients received one or a combination of the following treatment modalities:
anti-VEGF injections, frequency doubled Nd:Yag laser photocoagulation to polyps that
were extrafoveal and photodynamic therapy to polyps that were <200 lm away from the
foveal center
6. • Outcome measures included the final BCVA, the time to resolution of the
associated pigment epithelial detachment (PED, if present), the recurrence rate and
the associated side effects
• Inflammation is said to play a role in the pathogenesis of wet AMD (although it is
still considered inconclusive).
This study was undertaken with the aim of determining the role of oral
steroids in IPCV, specifically whether it alters visual recovery, IPCV
recurrence and PED resolution.
7. 14 (GROUP A)
Received Oral Steroids
26 (GROUP B)
Dint Receive Oral Steroids
9/14 Got Laser
& after 1 week
Got Anti-VEGF
Mean no.= 2.85 +/- 1.23
14/26 Got Laser
& 1 week after
Got Anti-VEGF
Mean no= 2.60 +/-1.32
Follow up 48.24 =/- 9.75
Follow Up 43.21+/-11.32 Months
12/26
Got PDT
5/14
Received PDT
1/14 had persistent PED 7/26 had persistent PED
Baseline VA 1.86 +/-1.24
3 Months VA 0.82 +/- 0.78
Both Groups had Large
PED`s
Baseline VA 2.12 +/- 1.48
3 Months VA 1.19+/-0.92
412+/-108 um 429+/-122 um
8.
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11. • This study shows greater visual benefit in patients of PCV who received steroids as
an adjunct to local therapy, contrary to other studies;
• It should, however, be borne in mind that this analysis was retrospective
• To conclude, oral steroids appear to improve visual outcomes and aid PED
resolution in patients with IPCV when prescribed as an adjunct to treatment.
• A randomized trial will help ascertain conclusively the role of steroids as an aid
to IPCV management.
