Polypoidal choroidal vasculopathy (PCV) is an age-related macular degeneration (AMD) subtype and is seen particularly in Asians. Previous studies have suggested disparity in response to intravitreal injections of anti–vascular endothelial growth factor (VEGF) agents between PCV and typical AMD, and thus, the preferred treatment for PCV has remained unclear. Recent research has provided novel insights into the pathogenesis of PCV, and imaging studies based on OCT suggest that PCV belongs to a spectrum of conditions characterized by pachychoroid, in which disturbance in the choroidal circulation seems to be central to its pathogenesis. Advances in imaging, including enhanced depth imaging, swept-source OCT, en face OCT, and OCT angiography, have facilitated the diagnosis of PCV. Importantly, 2 large, multicenter randomized clinical trials evaluating the safety and efficacy of anti-VEGF monotherapy and combination with photodynamic therapy (PDT) recently reported initial first-year outcomes, providing level I evidence to guide clinicians in choosing the most appropriate therapy for PCV. In this review, we summarize the latest updates in the epidemiologic features, pathogenesis, and advances in imaging and treatment trials, with a focus on the most recent key clinical trials. Finally, we propose current management guidelines and recommendations to help clinicians manage patients with PCV. Remaining gaps in current understanding of PCV, such as significance of polyp closure, high recurrence rate, and heterogeneity within PCV, are highlighted where further research is needed.

息肉样脉络膜血管病（PCV）是一种与年龄相关的黄斑变性（AMD）亚型，在亚洲人中尤为常见。先前的研究表明PCV和典型AMD在玻璃体内注射抗血管内皮生长因子（VEGF）药物的反应方面存在差异，因此，对于PCV的首选治疗方法仍不清楚。最近的研究为PCV的发病机理提供了新颖的见解，基于OCT的影像学研究表明PCV属于以脉络膜脉络膜为特征的一系列疾病，其中脉络膜循环中的紊乱似乎是其发病机理的中心。影像学的进步，包括增强的深度成像，扫频OCT，面对面OCT和OCT血管造影，已经促进了PCV的诊断。重要的是2大 评估抗VEGF单药疗法和光动力疗法（PDT）联合使用的安全性和有效性的多中心随机临床试验最近报告了第一年的初步结果，为指导临床医生选择最适合PCV的疗法提供了I级证据。在这篇综述中，我们总结了流行病学特征，发病机制以及影像学和治疗试验的最新进展，重点是最新的关键临床试验。最后，我们提出了当前的管理指南和建议，以帮助临床医生管理PCV患者。在需要进一步研究的地方，突出了当前对PCV的认识尚存的差距，例如息肉闭合的重要性，高复发率和PCV内的异质性。