Chinese Medical Sciences JournalOnline publication May 31,2023ISSN:10019294CN11-2752/Rdoi:10.24920/004213Guideline ConsensusChinese Guideline for the Management of PolypoidalChoroidal Vasculopathy (2022)You-Xin Chent12,Yu-Qing Zhangt3456,Chang-Zheng Chen?,Hong Dai,Su-Yan Li,Xiang Malo,Xiao-Dong Sun"1,Shi-Bo Tang12,Yu-Sheng Wang13,Wen-Bin Weil4,Feng Wen'5,Ge-Zhi Xul6,Wei-Hong Yu'2,Mei-Xia Zhang7,Ming-Wei Zhaol8,Yang Zhang19,Fang Qi9,Xun Xu20,Xiao-Xin Li*21,22 uhors'atsare lisied at the end of article)AbstractBackground In mainland China,patients with neovascular age-related macular degeneration (nAMD)have anapproximately 40%prevalence of polypoidal choroidal vasculopathy (PCV).This disease leads to polys,recurrent retinalpigment epithelium detachment(PED),extensive subretinal or vitreous hemorrhages,and severe vision loss.China hasintroduced various treatment modalities in the past years,and gaining comprehensive experience in treating PCV isnecessary.Methods A total of 14 retinal specialists nationwide with expertise in PCV were empaneled to prioritize six questionsand address their corresponding outcomes,regarding opinions on inactive PCV,choices of anti-vascular endothelialgrowth factor (anti-VEGF)monotherapy,photodynamic therapy(PDT)monotherapy or combined therapy,patients withpersistent subretinal fluid (SRF)or intraretinal fluid (IRF)after loading dose anti-VEGF,or patients with massivesubretinal hemorrhage.An evidence synthesis team conducted systematic reviews,which informed the recommendationsthat address these questions.This guideline used the GRADE(Grading of Recommendations,Assessment,Development,and Evaluation)approach to assess the evidence's certainty and grade the recommendations'strengths.Results The panel proposed the following six conditional recommendations regarding treatment choices:(1)Forpatients with inactive PCV,we suggest observation over treatment;(2)For treatment-naive PCV patients,we suggesteither anti-VEGF monotherapy or combined anti-VEGF and PDT rather than PDT monotherapy;(3)For patients withPCV who plan to initiate combined anti-VEGF and PDT treatment,we suggest later/rescue PDT over initiate PDT;(4)For PCV patients who plan to initiate anti-VEGF monotherapy,we suggest treat and extend(T&E)rather than the prorenata (PRN)regimen following three monthly loading doses;(5)For patients with persistent SRF or IRF on opticalcoherence tomography (OCT)after three monthly loading doses,we suggest proceeding with anti-VEGF treatmentrather than observation.(6)For PCV patients with massive subretinal hemorrhage (equal to or more than four papillarydiameters)involving the central macula,we suggest surgery (consider using a complementary therapy,e.g,pneumaticdisplacement,anti-VEGF,PDT,tissue-Plasminogen Activator [t-PA])rather than anti-VEGF monotherapy.Conclusions:Six evidence-based recommendations support optimal care for PCV patients'management.Keywords:polypoidal choroidal vasculopathy;anti-vascular endothelial growth factor
