Chinese Guideline for the Management of Polypoidal Choroidal Vasculopathy (2022).

Background In mainland China, patients with neovascular age-related macular degeneration (nAMD) have an approximately 40% prevalence of polypoidal choroidal vasculopathy (PCV). This disease leads to polys, 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 gaining comprehensive experience in treating PCV is necessary. 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, or 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 evidence's certainty and grade the recommendations' strengths. 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-na?ve 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 treat and extend (T&E) 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 loading doses, we suggest proceeding with anti-VEGF treatment rather than observation. (6) For PCV patients with massive subretinal hemorrhage (equal to or more than four papillary diameters) involving the central macula, we suggest surgery (consider using a complementary therapy, e.g., pneumatic displacement, 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.