Q&A: Giuseppe Querques on PVAC and TelCaps

Photo of Giuseppe Querques at EURETINA 2025 in Paris, France

Giuseppe Querques, MD, is the head of medical retina and imaging unit at University San Rafael Hospital and the scientific Institute. During the IntRIS symposium, at the 2025 EURETINA meeting in Paris, France, he presented on I on PVAC and TelCaps. The Eye Care Network spoke with Querques to learn more about this presentation.

Note: The following conversation has been lightly edited for clarity.

Ophthalmology Times: You presented during the IntRIS symposium here at the 2025 EURETINA meeting. Can you share a few of the key takeaways from this presentation?

Giuseppe Querques, MD: Actually, PVAC was described by my group and I, for the first time, long time ago. This will present the challenging form of macula-diseases, because challenging in the diagnosis, but also challenging in the treatment, because diagnosis may mimic other diseases. The treatment, unfortunately, typical treatment for exudated macula diseases, it seems not to work for PVAC. While treatment with laser, standard laser seems to be particularly effective. On the other hand, TelCaps is probably the same pathophysiology, but differently from PVAC, TelCaps is secondary to other diseases, so not primarily developing, but secondary to other diseases like diabetic retinopathy or retinal vein occlusion. The pathophysiology, as I said before is probably the same. This means that doesn't work properly the treatment with anti-VEGF, but treatment with laser may be particularly effective in these forms.

OT: What is the diagnosis process for these conditions?

Querques: Diagnosis could be particularly challenging. We really need to make a multi-modal imaging for cases with, particularly with PVAC, that is the primary form, because we need to put together all the information from, let's say, from OCT, structural OCT, Oct angiography, but also fluorescent angiography. This way, we can detect this tiny lesions that are could be extremely exudative, and based on this imaging, then we can make a differential diagnosis, for example, with other diseases that, on the other hand, may be particularly responsive to anti-VEGF treatment. One of this most important differential diagnosis is type 3 macular neurovascularization.

During my presentation, I will be presenting also the way to make differential diagnosis. Roughly, this is made by looking at the connection with the choroid. In PVAC, we never see this connection with the choroids, from the retina to the choroid, while with type 3 macular neovascularization, we typically see this connection. Again, PVAC doesn't respond to anti-VEGF, while we know that type 3 macular neovascularization responds very well to anti-VEGF.

OT: You are presenting on additional topics at EURETINA 2025. Can you share a bit about those?

Querques: Well, during the EURETINA meeting, I will be presenting 2 other important topics. One is the ultrawidefield imaging that is extremely important, because nowadays we cannot do without this imaging. There will be differentiating different devices that are available in the market the way they perform, particularly focusing on chromaticity. The other important talk that I will have during EURETINA is about treatment of intermediate AMD, and particularly the most aggressive form that is critical pseudodrucen, with sub threshold laser and other innovative technologies. Probably with this treatment, we will make progression of the intermediate form in preventing the progression towards the advanced form of AMD. My presentation was recently published on the survey Ophthalmology, and this is important to again, to have knowledge about PVAC and TelCaps. Because, said, before the treatment could be challenging, could be challenging because typical treatment that this anti-VEGF doesn't work in PVAC and in TelCaps. So I could suggest to colleagues to have a look also at this publication.