Chinese Medical Sciences Journal ›› 2023, Vol. 38 ›› Issue (2): 77-93.doi: 10.24920/004213

• Guideline & Consensus •     Next Articles

Chinese Guideline on the Management of Polypoidal Choroidal Vasculopathy (2022)

You-Xin Chen1, 2, Yu-Qing Zhang3, 4, 5, 6, Chang-Zheng Chen7, Hong Dai8, Su-Yan Li9, Xiang Ma10, Xiao-Dong Sun11, Shi-Bo Tang12, Yu-Sheng Wang13, Wen-Bin Wei14, Feng Wen15, Ge-Zhi Xu16, Wei-Hong Yu1, 2, Mei-Xia Zhang17, Ming-Wei Zhao18, Yang Zhang19, Fang Qi19, Xun Xu20, *(), Xiao-Xin Li21, 22, *()   

  1. 1Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
    2Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
    3Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
    4Ningbo Nottingham GRADE center, University of Nottingham, Ningbo, China
    5Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
    6CEBIM (Center for Evidence Based Integrative Medicine)-Clarity Collaboration, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
    7Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
    8Department of Ophthalmology, Beijing Hospital, Beijing, China
    9Department of Ophthalmology, Xuzhou Municipal Hospital Affiliated to Xuzhou medical University, Xuzhou, China
    10Department of Ophthalmology, the First Affiliated Hospital of Dalian Medical University, Dalian, China
    11Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
    12Aire Eye Hospital, Changsha, China
    13Department of Ophthalmology, Xijing Hospital, Fouth Military Medical University, Xi‘an, China
    14Department of Ophthalmology, Beijing Tongren Hospital, Beijing, China
    15State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
    16Ophthalmology, the Affiliated Eye and ENT Hospital, Shanghai Medical School, Fudan University, Shanghai, China
    17Department of Ophthalmology, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
    18Department of Ophthalmology, Peking University People’s Hospital, Beijing, China
    19Department of Ophthalmology, Peking University People’s Hospital, Beijing, China
    20Department of Ophthalmology, Shanghai General Hospital, Shanghai, China
    21Eye Center of Xiamen University, Xiamen, China
    22People Eye Center of People’s Hospital, Peking University, Beijing, China
  • Accepted:2023-04-06 Published:2023-06-30 Online:2023-05-31
  • Contact: *Xun Xu, E-mail:; Xiaoxin Li, E-mail:

Background In mainland China, patients with neovascular age-related macular degeneration (nAMD) have approximately an 40% prevalence of polypoidal choroidal vasculopathy (PCV). This disease leads to recurrent retinal pigment epithelium detachment (PED), extensive subretinal or vitreous hemorrhages, and severe vision loss. China has introduced various treatment modalities in the past years and gained comprehensive experience in treating PCV.

Methods A total of 14 retinal specialists nationwide with expertise in PCV were empaneled to prioritize six questions and address their corresponding outcomes, regarding opinions on inactive PCV, choices of anti-vascular endothelial growth factor (anti-VEGF) monotherapy, photodynamic therapy (PDT) monotherapy or combined therapy, patients with persistent subretinal fluid (SRF) or intraretinal fluid (IRF) after loading dose anti-VEGF, and patients with massive subretinal hemorrhage. An evidence synthesis team conducted systematic reviews, which informed the recommendations that address these questions. This guideline used the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach to assess the certainty of evidence and grade the strengths of recommendations.

Results The panel proposed the following six conditional recommendations regarding treatment choices. (1) For patients with inactive PCV, we suggest observation over treatment. (2) For treatment-naïve PCV patients, we suggest either anti-VEGF monotherapy or combined anti-VEGF and PDT rather than PDT monotherapy. (3) For patients with PCV 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 the treat and extend (T&E) regimen rather than the pro re nata (PRN) regimen following three monthly loading doses. (5) For patients with persistent SRF or IRF on optical coherence tomography (OCT) after three monthly anti-VEGF treatments, we suggest proceeding with anti-VEGF treatment rather than observation. (6) For PCV patients with massive subretinal hemorrhage (equal to or more than four optic disc areas) involving the central macula, we suggest surgery (vitrectomy in combination with tissue-plasminogen activator (tPA) intraocular injection and gas tamponade) rather than anti-VEGF monotherapy.

Conclusions Six evidence-based recommendations support optimal care for PCV patients’ management.

Key words: polypoidal choroidal vasculopathy, anti-vascular endothelial growth factor, photodynamic therapy, surgery

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