title: Polypoidal choroidal vasculopathy masquerading as neovascular age-related macular degeneration refractory to ranibizumab.
abstract: OBJECTIVE
  To report a neovascular age-related macular degeneration pattern refractory to ranibizumab.
  
  
  METHODS
  Retrospective, observational case series.
  
  
  METHODS
  Between March and May 2009, cases with neovascular age-related macular degeneration refractory to ranibizumab were investigated with indocyanine green angiography. We identified 12 eyes of 12 patients with polypoidal choroidal vasculopathy. Refractory to treatment were defined cases with persistent subretinal or intraretinal fluid, or both, after 3 or more consecutive monthly ranibizumab injections regardless of best-corrected visual acuity.
  
  
  RESULTS
  All patients identified were white, of whom 6 were male. Mean age ± standard deviation at presentation was 75 ± 5.6 years (range, 64 to 81 years); diagnosis, based on fluorescein angiography, comprised occult choroidal neovascularization (CNV) in 8 eyes, and 1 case each of classic-no-occult CNV, minimally classic CNV, predominantly classic CNV, and retinal angiomatous proliferation. Eight cases had switched from courses of other therapy (5 pegaptanib, 1 photodynamic therapy, 1 photodynamic therapy then pegaptanib, 1 bevacizumab). After a mean follow-up of 10.2 ± 4.8 months (range, 3 to 18 months) and 7.6 ± 3.9 ranibizumab injections (range, 3 to 14 injections), indocyanine green angiography revealed polypoidal choroidal vasculopathy lesions in all cases.
  
  
  CONCLUSIONS
  Neovascular age-related macular degeneration refractory to a course of ranibizumab injections may harbor polypoidal choroidal vasculopathy. In such cases, indocyanine green angiography is a valuable tool for revealing polypoidal lesions.
authors: Royal Liverpool University Hospital, United Kingdom. astangos@hotmail.com
authors: Alexandros N
authors: AN
authors: Stangos
authors: Jagdeep Singh
authors: JS
authors: Gandhi
authors: Jayashree
authors: J
authors: Nair-Sahni
authors: Heinrich
authors: H
authors: Heimann
authors: Constantin J
authors: CJ
authors: Pournaras
authors: Simon P
authors: SP
authors: Harding
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D002829:Choroid / Q000098:blood supply*; D015862:Choroid Diseases / Q000175:diagnosis*; D020256:Choroidal Neovascularization / Q000175:diagnosis* / Q000188:drug therapy; D003937:Diagnosis, Differential; D004351:Drug Resistance; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green; D008268:Macular Degeneration / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000175:diagnosis*; D011127:Polyps / Q000175:diagnosis; D000069579:Ranibizumab; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007208:Indocyanine Green; D000069579:Ranibizumab