PMID- 30390650 OWN - NLM STAT- MEDLINE DCOM- 20181114 LR - 20181114 IS - 1471-2415 (Electronic) IS - 1471-2415 (Linking) VI - 18 IP - 1 DP - 2018 Nov 3 TI - Complete regression of branching vascular network in polypoidal choroidal vasculopathy by ranibizumab and photodynamic therapy, two case reports. PG - 284 LID - 10.1186/s12886-018-0952-6 [doi] LID - 284 AB - BACKGROUND: Polypoidal choroidal vasculopathy (PCV) consists of polyps that potentially cause massive subretinal hemorrhage and their branching vascular network (BVN) of feeder vessels. Although conventional indocyanine green angiography (IA) has shown anti-vascular endothelial growth factor (VEGF) agents and/or photodynamic therapy (PDT) to successfully induce polyp closure, the BVN appears resistant to these therapies and serves as the origin of recurrent active polyps. Recently introduced optical coherence tomography angiography (OCT-A) enables more frequent angiographic evaluation of polyps and the BVN than does conventional IA since it does not require intravenous fluorescent dye injection and is thus considered non-invasive. CASE PRESENTATION: Case 1. A 70-year-old male with PCV in his left eye suffered from vision deterioration (20/40) due to persistent subretinal fluid despite 42 intravitreal injections of ranibizumab (IVRs) over 5 years and 7 months. PDT was performed as an adjunct therapy 3 days after the 43rd IVR. IA at 3 months after PDT showed successful polyp closure but persisting BVN. However, more frequent evaluation with OCT-A starting at 1 week after PDT demonstrated complete regression of both the BVN and polyp. OCT-A at every subsequent outpatient visit depicted gradual re-perfusion of the BVN and the restoration of most of its original network at 3 months, which was compatible with IA findings. Neither OCTA nor IA revealed polyp recurrence at 3 months. Case 2. A 65-year-old female suffering from left vision deterioration due to PCV underwent 5 intravitreal injections of aflibercept. Since her subretinal fluid persisted, the treatment was switched to a combination of IVR and PDT. OCT-A revealed marked regression of the BVN and polyp at 2 weeks, but the BVN had regained its original shape at 2 months without any sign of polyp recurrence. CONCLUSIONS: Differently from previous observations obtained by IA alone, more frequent non-invasive OCT-A examination revealed complete but transient regression of the BVN just after combination therapy with IVR and PDT. FAU - Iesato, Yasuhiro AU - Iesato Y AD - Department of Ophthalmology, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan. FAU - Tanaka, Masaaki AU - Tanaka M AD - Department of Ophthalmology, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan. FAU - Murata, Masako AU - Murata M AD - Department of Ophthalmology, Matsumoto Medical Center, Narional Hospital Organaization, 2-20-30 Murai-Minami, Matsumoto, Nagano, 390-8621, Japan. FAU - Kitahara, Junya AU - Kitahara J AD - Department of Ophthalmology, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan. FAU - Hirano, Takao AU - Hirano T AD - Department of Ophthalmology, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan. FAU - Kurenuma, Taihei AU - Kurenuma T AD - Department of Ophthalmology, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan. FAU - Yoshida, Noriko AU - Yoshida N AD - Department of Ophthalmology, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan. FAU - Murata, Toshinori AU - Murata T AUID- ORCID: 0000-0001-6577-5032 AD - Department of Ophthalmology, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan. murata@shinshu-u.ac.jp. LA - eng PT - Case Reports PT - Journal Article DEP - 20181103 PL - England TA - BMC Ophthalmol JT - BMC ophthalmology JID - 100967802 RN - 0 (Angiogenesis Inhibitors) RN - 0 (Photosensitizing Agents) RN - 0 (Porphyrins) RN - 0 (Vascular Endothelial Growth Factor A) RN - ZL1R02VT79 (Ranibizumab) SB - IM MH - Aged MH - Angiogenesis Inhibitors/administration & dosage MH - Choroid/*blood supply MH - Choroid Diseases/diagnosis/*drug therapy MH - Female MH - Fluorescein Angiography MH - Follow-Up Studies MH - Fundus Oculi MH - Humans MH - Intravitreal Injections MH - Male MH - Photochemotherapy/*methods MH - Photosensitizing Agents/administration & dosage MH - Polyps/diagnosis/*drug therapy MH - Porphyrins/*administration & dosage MH - Ranibizumab/*administration & dosage MH - Tomography, Optical Coherence MH - Vascular Endothelial Growth Factor A/antagonists & inhibitors MH - *Visual Acuity PMC - PMC6215629 OTO - NOTNLM OT - Branching vascular network OT - Optical coherence tomography angiography OT - Photodynamic therapy OT - Polypoidal choroidal vasculopathy OT - Polypoidal lesions OT - Ranibizumab COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: Not applicable. CONSENT FOR PUBLICATION: Written informed consent was obtained from each patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the editor of this journal. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2018/11/06 06:00 MHDA- 2018/11/15 06:00 PMCR- 2018/11/03 CRDT- 2018/11/05 06:00 PHST- 2018/04/30 00:00 [received] PHST- 2018/10/23 00:00 [accepted] PHST- 2018/11/05 06:00 [entrez] PHST- 2018/11/06 06:00 [pubmed] PHST- 2018/11/15 06:00 [medline] PHST- 2018/11/03 00:00 [pmc-release] AID - 10.1186/s12886-018-0952-6 [pii] AID - 952 [pii] AID - 10.1186/s12886-018-0952-6 [doi] PST - epublish SO - BMC Ophthalmol. 2018 Nov 3;18(1):284. doi: 10.1186/s12886-018-0952-6.