Secondary polypoidal choroidal vasculopathy (PCV)

Abstract

AbstractPolypoidal choroidal vasculopathy (PCV) was first described as polypoidal, subretinal, vascular lesions associated with serous and hemorrhagic detachments of the retinal pigment epithelium (RPE) in a series of patients (10/11 were women) by Yannuzzi. PCV is most commonly diagnosed in patients between the ages of 50 and 65 years. Although more frequently being an primary disease associated to high blood pressure, it may also be secondary to others diseases such as AMD, Central Serous Chorioretinopathy (CSC), ocular radiotherapy, Pseudoxanthoma Elasticum not related to systemic hypertension. Secondary PCV was first reported to occur in AMD patients. Prevalence rates of 4%, 7.8%, 8.2%, and 9.8% have been reported in Caucasian patients with presumed age‐related macular degeneration (AMD). In Asian patients with diagnosed AMD the prevalence rates are even higher, between 23.9% and 54.7%. PCV was categorized as a subtype of neovascular AMD. Vascular proliferative changes associated with PCV in AMD form a network of vessels ending with saccular polypoidal lesions. ICG angiography can be used to distinguish it from classic or occult CNV as usually seen in AMD. PCV is demonstrated by ICG angiography as a prominent vascular network in the early stages of the study and an area of clearing or so called “washout” of the dye in the late stage. On OCT examination the polypoidal lesions are seen as more steep domelike elevations of the highly reflective RPE layers with underlying moderate reflectivity then seen in PEDs. The regions of the branching choroidal vascular networks are visualized as double reflective layers comprising nodular RPE and another highly reflective layer beneath the RPE. According to the EVERST and LAPTOP studies either Anti‐VEGF monotherapy alone or associated to Photodynamic therapy is the best therapeutic option actually available to treat PCV in AMD patients and should be considered as first line therapy in all secondary cases.