title: Systemic steroids as an aid to the management of Idiopathic Polypoidal Choroidal Vasculopathy (IPCV): A descriptive analysis.
abstract: OBJECTIVE
  To determine the role of systemic steroids in improving visual acuity, preventing recurrence and hastening pigment epithelial detachment resolution in IPCV patients.
  
  
  METHODS
  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 contraindication 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. 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, if any. Appropriate statistical analysis was done. Statistical significance: p < 0.05.
  
  
  RESULTS
  14 patients (14 eyes) had received systemic steroids in the stated period; these were compared with 26 consecutive patients (26 eyes) who did not. Mean age: 59.24 vs 62.38 years (A vs B). Mean baseline BCVA: 1.86 ± 1.24 logMAR vs 2.12 ± 1.48 logMAR (A vs B). 8 females in Group A and 14 in Group B. 11 patients in group A and 19 in group B had associated systemic hypertension. Therapy consisted of laser photocoagulation, anti-vascular endothelial growth factor therapy, photodynamic therapy or a combination of these. Mean follow-up: 43.21 ± 11.32 months (Group A) vs 48.24 ± 9.75 months (Group B). BCVA at three months was significantly better (0.84 ± 0.74 logMAR vs 1.16 ± 0.89 (p = 0.039). Final BCVA: 0.86 ± 0.78 logMAR (Group A) vs 1.29 ± 0.92 (Group B, p = 0.042). 7 patients in group A and 12 in Group B had a recurrence (insignificant difference). 1 patient in Group A and 7 in Group B had unresolved disease (persistent PED) at the end of follow-up (OR: 4.60; 95% CI 1.7-11.10).
  
  
  CONCLUSIONS
  Steroids appear to improve visual acuity and accelerate the resolution of the PEDs in patients with IPCV and large PEDs, but do not seem to influence recurrence.
authors.affiliation: Smt. Kanuri Santhamma Centre For Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India.
authors.forename: Aditya
authors.initials: A
authors.lastname: Sudhalkar
authors.affiliation: Smt. Kanuri Santhamma Centre For Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India.
authors.forename: Divya
authors.initials: D
authors.lastname: Balakrishnan
authors.affiliation: Smt. Kanuri Santhamma Centre For Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India.
authors.forename: Subhadra
authors.initials: S
authors.lastname: Jalali
authors.affiliation: Smt. Kanuri Santhamma Centre For Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India.
authors.forename: Raja
authors.initials: R
authors.lastname: Narayanan
keywords: Pigment epithelial detachment; Polypoidal choroidal vasculopathy; Recurrence; Steroids; Systemic