title: Refractory neovascular age-related macular degeneration secondary to polypoidal choroidal vasculopathy.
abstract: OBJECTIVE
  To describe a neovascular pattern associated with treatment-refractory neovascular age-related macular degeneration (AMD).
  
  
  METHODS
  A retrospective observational case series.
  
  
  METHODS
  
  
  
  METHODS
  Clinical practice.
  
  
  METHODS
  Twelve eyes of 12 patients with neovascular AMD in which a poor anatomic response to anti-vascular endothelial growth factor (VEGF) therapy was related to polypoidal choroidal vasculopathy (PCV).
  
  
  METHODS
  Slit-lamp biomicroscopy, optical coherence tomography, fluorescein and indocyanine green angiography.
  
  
  METHODS
  Snellen visual acuity (VA), anatomic response to therapy including presence or absence of retinal edema, hemorrhage, and lipid exudates.
  
  
  RESULTS
  New or persistent PCV was identified in a cohort of patients demonstrating increasing macular exudation despite regular intravitreal ranibizumab (Lucentis; Genentech Inc, South San Francisco, California, USA) or bevacizumab (Avastin; Genentech Inc) injections for a minimum of 6 months. Treatment with verteporfin photodynamic therapy (PDT), PDT/anti-VEGF combination therapy, or continued anti-VEGF monotherapy resulted in complete resolution of exudation in 9 of 12 patients and partial resolution of exudation in the remaining 3 patients.
  
  
  CONCLUSIONS
  Treatment-refractory neovascular AMD may harbor vascular abnormalities such as PCV. Modifications in therapeutic protocols may be indicated in order to improve visual and anatomic outcomes in this population.
authors.affiliation: New York University School of Medicine/Manhattan Eye, Ear & Throat Hospital, Department of Ophthalmology, New York, New York, USA.
authors.forename: Minhee
authors.initials: M
authors.lastname: Cho
authors.forename: Irene A
authors.initials: IA
authors.lastname: Barbazetto
authors.forename: K Bailey
authors.initials: KB
authors.lastname: Freund
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D002829:Choroid / Q000098:blood supply*; D020256:Choroidal Neovascularization / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D004396:Coloring Agents; D003131:Combined Modality Therapy; D004351:Drug Resistance; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green; D008268:Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011166:Porphyrins / Q000627:therapeutic use; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D000077362:Verteporfin; D014792:Visual Acuity / Q000502:physiology
chemical_list: D020533:Angiogenesis Inhibitors; D004396:Coloring Agents; D017319:Photosensitizing Agents; D011166:Porphyrins; D042461:Vascular Endothelial Growth Factor A; D000077362:Verteporfin; D007208:Indocyanine Green