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Polypoidal Choroidal Vasculopathy

Home / Retina and Vitreous / Age-Related Macular Degeneration and other Causes of Choroidal Neovascularizaton

Title: Polypoidal Choroidal Vasculopathy
Authors: Marlow Schulz, BS; Brian Solinsky, MD; Paul Bernstein, MD
Date: June 23, 2024
Keywords/Main Subjects: Polypoidal Choroidal Vasculopathy, PCV
Diagnosis: Polypoidal Choroidal Vasculopathy (PCV)

Description of Case: This patient is a 64-year-old male of Asian heritage with an ocular history of high myopia and no significant past medical history presenting with one year of gradually worsening vision in his left eye. He reported that around three weeks ago, the vision in his left eye acutely became even more blurry, prompting him to present for evaluation. He denied flashes of light or floaters in his vision, denies any vision changes in the right eye, and denies recent head or eye trauma. His best corrected visual acuity on presentation was 20/15 OD and 20/80 OS. Tonometry, pupils, visual fields, and extraocular movements were all normal. Anterior chamber exam was notable for trace nuclear sclerosis of the lens, otherwise unremarkable. Color fundus photography demonstrated subretinal pigment epithelium and diffuse macular exudates (A). Optical coherence tomography (OCT) demonstrated significant sub-retinal fluid (SRF) with sub-foveal fluid (B), and a large fibrovascular pigment epithelial detachment in the temporal macula. Fluorescein angiogram (FA) showed a large area of hyperfluorescense in the temporal macula with leakage (C) and Indocyanine Green Angiography (ICG) demonstrated a polyp in the choroidal vasculature (D). The patient was subsequently treated with intravitreal Avastin and photodynamic therapy. Post-treatment OCT showed a significant reduction in SRF (D), FA demonstrated resolution of leakage (E).

Polypoidal choroidal vasculopathy (PCV) is a macular disease characterized by an abnormality in the choroidal blood vessels. This condition is considered a subtype of age-related macular degeneration (AMD), though it has distinct clinical features. Of note, it is more commonly diagnosed in patients of Asian or African heritage, with 23-62% of those with neovascular AMD also carrying this diagnosis, compared to 8-13% of Caucasian patients.

The hallmark of PCV is the presence of polyp-like, dilated blood vessels in the choroid, typically located at the border of branching vascular networks. PCV can cause fluid accumulation or bleeding beneath the retina, leading to serous or hemorrhagic detachments respectively. This can lead to blurred or distorted vision, scotomas in the central vision, as well as a sudden decreased in vision related to new fluid accumulation. Treatment includes a combination of anti-VEGF therapy to reduce fluid and stabilize abnormal blood vessels, photodynamic therapy to selectively target abnormal blood vessels, as well as laser photocoagulation in some cases. PCV requires ongoing monitoring and treatment to manage symptoms and preserve vision, as it can be a chronic and recurring condition.

 

Images:

 

Shulz, Figure 1

A. Color fundus photography at presentation

 

Shulz, Figure 2

B. OCT images at presentation

Shulz, Figure 3

B. OCT images at presentation

 

Shulz, Figure 4

C. FA at presentation

Shulz, Figure 5

C. FA at presentation

 

Shulz, Figure 6

D. ICG at presentation

 

Shulz, Figure 7

E. Post-treatment OCT

 

Shulz, Figure 8

F. Post-treatment FA

 

Summary of the Case: Polypoidal choroidal vasculopathy (PCV) is a subtype of age-related macular degeneration (AMD) more prevalent among patients of Asian or African heritage, accounting for 23-62% of neovascular AMD cases in these populations compared to 8-13% in Caucasian patients. PCV is characterized by the presence of polyp-like, dilated blood vessels in the choroid, which can lead to fluid accumulation or bleeding beneath the retina. This condition often manifests as blurred or distorted vision, scotomas, and sudden vision decrease due to new fluid accumulation. Treatment for PCV typically involves a combination of anti-VEGF therapy to reduce fluid and stabilize abnormal blood vessels, photodynamic therapy to selectively target these vessels, and sometimes laser photocoagulation. Due to its chronic and recurring nature, PCV requires ongoing monitoring and treatment to manage symptoms and preserve vision.

 

References:

 

Faculty Approval by: Paul Bernstein, MD

Copyright statement: Copyright Marlow Schulz; Brian Solinsky, MD; Paul Bernstein, MD, ©2024. For further information regarding the rights to this collection, please visit: http://morancore.utah.edu/terms-of-use/