Polypoidal Choroidal Vasculopathy Lesions Research Articles

Recent Advances in Imaging Polypoidal Choroidal Vasculopathy with Swept-Source Optical Coherence Tomography Angiography.

The gold standard for polypoidal choroidal vasculopathy (PCV) diagnosis is indocyanine green angiography (ICGA), but optical coherence tomography angiography (OCTA) has shown promise for PCV imaging in recent years. However, earlier generations of OCTA technology lacked the diagnostic efficacy to replace ICGA. Swept-source optical coherence tomography angiography (SS-OCTA), the latest generation of OCTA technology, has significantly improved penetrating ability, scanning speed, scanning range, and overall image quality compared with earlier generations of OCTA. SS-OCTA reveals a "tangled vasculature" pattern of polypoidal lesions (PLs), providing evidence that they are neovascular rather than aneurysmal structures. New choroidal biomarkers, such as the choriocapillaris flow void (FV), have been identified to explain the development of PCV lesions. Although no direct comparison between SS-OCTA and previous OCTA generations in terms of diagnostic capability has been performed, SS-OCTA has shown several advantages in differential diagnosis and monitoring early reactivation for PCV. These improvements make SS-OCTA a valuable tool for PCV diagnosis and follow-up, and it may become more important for this disease in the future. This review summarized recent advances in PCV morphology and structure, as well as the possible pathogenesis based on SS-OCTA findings. The value of SS-OCTA for PCV management is discussed, along with remaining issues, to provide an updated understanding of PCV and OCTA-guided management.

Incidence and multimodal imaging characteristics of macular neovascularisation subtypes in Chinese neovascular age-related macular degeneration patients

AimsTo investigate the incidence of macular neovascularisation (MNV) subtypes of neovascular age-related macular degeneration (nAMD) and summarise these subtypes’ clinical features in the Chinese population using multimodal imaging.MethodsWe retrospectively analysed...

Indocyanine green angiographic documentation of regression of polypoidal lesions after brolucizumab injection in polypoidal choroidal vasculopathy

An elderly male presented with complaints of decrease in vision in the left eye since 1 week. He had a recurrent submacular hemorrhage secondary to polypoidal choroidal vasculopathy (PCV) and was treated with intravitreal brolucizumab. There was complete resolution of subretinal fluid and improvement in visual acuity to 20/20 on follow-up. Indocyanine green angiography at 1 year showed complete regression of polypoidal lesions. This case report highlights the role of brolucizumab as an effective treatment option in resistant PCV and its role in regression of polypoidal lesions in PCV.

Progression of Polypoidal Lesions Associated with Exudative Recurrence in Polypoidal Choroidal Vasculopathy

To investigate the characteristics of the branching vascular network (BVN) and polypoidal lesions in polypoidal choroidal vasculopathy (PCV) to determine near-term indicators that may predict exudative recurrence. Retrospective cohort study. Patients with PCV receiving anti-vascular endothelial growth factor (VEGF) monotherapy or anti-VEGF plus photodynamic therapy were followed for at least 1 year using swept-source OCT angiography (SS-OCTA) imaging. Patients were divided into 2 groups based on whether exudative recurrence occurred during follow-up. Multiple parameters were collected and compared between the 2 groups, such as age, gender, visual acuity, number of polypoidal lesions, lesion area at the first SS-OCTA visit, and total lesion area change from the first SS-OCTA visit to the last SS-OCTA visit. To evaluate the association between SS-OCTA imaging-based risk factors and the exudative recurrences, imaging features associated with PCV such as BVN growth and polypoidal lesion progression (enlargement, new appearance, and reappearance) at each follow-up visit were analyzed. The time intervals from the nonexudative visit with lesion progression to the corresponding exudative recurrence visit were documented to explore their association with exudative recurrences. Cox regression and logistic regression analyses were used. Association between BVN growth and polypoidal lesion progression with exudative recurrence. Thirty-one eyes of 31 patients (61% men) were included. Sixteen eyes had no recurrence of exudation, and 15 eyes had recurrence during follow-up. The average follow-up duration was 20.55 ± 6.86 months (range, 12-36 months). Overall, the recurrence group had worse best-corrected visual acuity (P= 0.019) and a greater increase in lesion area (P= 0.010). Logistical regression analysis showed that polypoidal lesion progression, including new appearance, enlargement, and reappearance of polypoidal lesions, was associated with exudative recurrences within 3 months (odds ratio, 26.67, 95% confidence interval, 3.77-188.54, P= 0.001). Growth of nonexudative BVN and progression of polypoidal lesions were found to be lesion characteristics associated with exudative recurrences, and progression of polypoidal lesions might serve as a stand-alone indicator for the near-term onset of exudation. In PCV, more frequent follow-up visits are recommended when polypoidal lesions show progression.

Clinicopathological study of the polypoidal lesions of polypoidal choroidal vasculopathy.

To investigate the pathogenic features of the polypoidal lesions from the specimens of polypoidal choroidal vasculopathy extracted from human subjects. Seven specimens of polypoidal lesions extracted from five eyes of six patients (mean age, 60.16 ± 10.41years) of polypoidal choroidal vasculopathy were examined. The polypoidal lesions were obtained by surgical excision. Thereafter, a histopathological analysis of the specimens was performed. The polypoidal lesions were oval nodules located underneath the retinal pigment epithelium. A pathological study of the lesions revealed that Bruch's membrane schisis was observed in all specimens and they were all located in the Bruch's membrane. The Bruch's membrane schisis and serosanguineous materials constituted the main structure of the lesions in five of the seven specimens, with small vessels being observed in two specimens. One specimen was composed of two polypoidal lesions of different characteristics, and one specimen had a neovessel membrane complex with several polypoidal lesions. Inflammatory cells and blood vessels were observed in the polypoidal lesion of the specimen with neovessel membrane complex. Polypoidal lesions of polypoidal choroidal vasculopathy are abnormalities of the Bruch's membrane. The lesions are characterized by the Bruch's membrane schisis, which is filled with serosanguineous materials. The lesions are progressive and may contain inflammatory cells and blood vessels.

Choroidal Changes in Eyes With Polypoidal Choroidal Vasculopathy After Anti-VEGF Therapy Imaged With Swept-Source OCT Angiography.

PurposeSwept-source optical coherence tomography angiography was used to investigate choroidal changes and their association with pigment epithelial detachments (PEDs) in eyes with polypoidal choroidal vasculopathy (PCV) after treatment with vascular endothelial growth factor (VEGF) inhibitors.MethodsPatients with treatment-naïve PCV were included and underwent anti-VEGF therapy. Mean choroidal thickness (MCT), choroidal vascularity index (CVI), and PED volume measurements were obtained before and after treatment.ResultsThirty-four treatment-naïve PCV eyes from 33 patients were included. The PED volume decreased after treatment (P < 0.05). The MCT decreased from 223.0 ± 79.6 µm at baseline to 210.9 ± 76.2 µm after treatment (P < 0.001). The CVI at baseline was 0.599 ± 0.024, and the CVI after treatment was 0.602 ± 0.023 (P = 0.16). There was a correlation between the decreased PED volumes and the decreased MCT measurements (r = 0.47; P = 0.006). Also, there was a correlation between the decreased PED volumes and the increased CVI measurements (r = −0.63; P < 0.001).ConclusionsIn treatment-naïve eyes with PCV, the decreases in PED volumes were correlated with the decrease in MCT and the increase in CVI measurements. We propose that, at baseline, the PCV lesions serve as high-volume arteriovenous shunts between choroidal arterial and venous circulation, causing transudation into the choroidal stroma. We propose that, after treatment, the blood flow through the vascular shunt is reduced, the excess stromal transudation is resorbed, and the exudation from the neovascular lesion is reduced, resulting in thinning of the choroid, resolution of the PEDs, and an increase in the CVI due to the resorption of excess choroidal transudation.

Characteristics of polypoidal choroidal vasculopathy in the Malaysian population

Introduction: Polypoidal choroidal vasculopathy (PCV) is a distinct clinical entity, characterized by focal hyperfluorescence in the early phase of indocyanine green angiography (ICGA), with or without its associated branching vascular network (BVN).Purpose: To report the angiographic characteristics of PCV on ICGA in presumed PCV patients.Study design: Descriptive cross-sectional study.Materials and methods: This study involved 36 suspected PCV patients who attended the Ophthalmology Clinic, Universiti Kebangsaan Malaysia Medical Centre from June 1, 2012 to May 31, 2013. All patients underwent complete ophthalmologic examination including colour fundus photography, ICGA, and fundus fluorescein angiography. ICGA images of confirmed PCV patients were analysed.Results: Twenty-five out of 36 eyes (69.4%) were diagnosed to have PCV based on ICGA. Mean age of confirmed PCV patients was 66.4 ± 8.42 years, with predominance of males (n = 17) and Chinese ethnicity (n = 19). Best-corrected visual acuity (BCVA) was between 6/6 and 6/18 in 64%. All 25 patients had unilateral disease. Average size of PCV lesions was 1461.4 ± 864.4 μm. The lesions were mostly concentrated in the extrafoveal region (n = 15, 60%). Lesion formation was cluster in 56% (n = 14), single in 32% (n = 8), string in 4% (n = 1), and combination in 8% (n = 2). The majority involved a single discrete area. Polyp pulsation was detected in six eyes, while seven eyes revealed nodular hyperfluorescence when viewed stereoscopically. BVN was evident in 56% (n = 14). Fifteen eyes demonstrated the hypofluorescent halo, while no hyperfluorescent ring was seen in this study population. Late geographical hyperfluorescence (LGH) was noted in seven eyes (28%). There was no significant association between the morphological characteristics of PCV, i.e., size of lesion, location, formation, discrete area involved, and LGH with BCVA.Conclusion: The demographic, clinical, and angiographic features observed in this study were in agreement with other previously published Asian studies. However, we found no association between the morphological characteristics of PCV with BCVA.

Comparison of Polypoidal Choroidal Vasculopathy Lesion Sizes Measured on Multicolor Imaging and Indocyanine Green Angiography.

PurposeTo evaluate the areas of lesion components of polypoidal choroidal vasculopathy (PCV) measured using multicolor imaging compared to indocyanine green angiography (ICGA).MethodsIn a prospective study of 50 consecutive treatment-naïve PCV patients, multicolor imaging and ICGA were performed. The images were independently graded by reading center-certified retinal specialists to confirm the diagnosis of PCV and identify lesion components. The areas of the respective lesion components were compared.ResultsThe mean age of the participants was 67.8 years. PCV was diagnosed in 96% of eyes using multicolor imaging. The mean numbers of polypoidal lesions identified using ICGA and multicolor were 4.0 and 2.1, respectively (P < 0.001), with mean total polypoidal lesion areas of 0.32 mm2 versus 0.30 mm2 (P = 0.727). The area of the branching vascular network (BVN) on ICGA was 7.8 mm2 compared to 5.7 mm2 on multicolor imaging (P = 0.289). Patients with four or more polypoidal lesions on ICGA had larger differences in total lesion area between ICGA and multicolor imaging (4.07 vs. –0.70 mm2, p = 0.039). Those with total lesion area ≥ 2.0 mm2 on ICGA had larger differences in mean polypoidal lesion number compared to those with smaller areas (2.2 vs. 0.5; P = 0.026).ConclusionsMulticolor imaging is a useful, noninvasive adjunct for detecting PCV lesion components, revealing lesion areas similar to but generally smaller than those seen on ICGA. This is important to consider when making treatment decisions with different imaging modalitiesTranslational RelevanceNew features seen on multicolor imaging can aid in the diagnosis and treatment of PCV.

POLYPOIDAL CHOROIDAL VASCULOPATHY FEATURES VARY ACCORDING TO SUBFOVEAL CHOROIDAL THICKNESS.

To evaluate associations between choroidal thickness and features of polypoidal choroidal vasculopathy (PCV) lesions based on multimodal imaging. This cross-sectional analysis included treatment-naive PCV eyes from a prospectively recruited observational cohort. Associations between of subfoveal choroidal thickness (SFCT) and qualitative and quantitative morphologic features of PCV lesions on color fundus photographs, indocyanine green and fluorescein angiography, and spectral-domain optical coherence tomography were evaluated. We included 100 eyes with indocyanine green angiography-proven PCV. Subfoveal choroidal thickness showed a bimodal distribution with peaks at 170 µm and 350 µm. There was a significant linear increase in the total lesion area (P-trend = 0.028) and the polypoidal lesion area (P-trend = 0.030 and P-continuous = 0.037) with increasing SFCT. Pairwise comparisons between quartiles showed that the total lesion area (4.20 ± 2.61 vs. 2.89 ± 1.43 mm2, P = 0.024) and the polypoidal lesion area (1.03 ± 1.01 vs. 0.59 ± 0.45 mm2, P = 0.042) are significantly larger in eyes in Q4 (SFCT ≥ 350 μm) than eyes in Q1 (SFCT ≤ 170 μm). Although there was no significant linear trend relating SFCT to best-corrected visual acuity, pairwise comparisons showed that eyes in Q4 (SFCT ≥ 350 μm) have significantly worse vision (0.85 ± 0.63 vs. 0.55 ± 0.27 logMAR, P = 0.030) than eyes in Q2 (SFCT 170-260 μm). Total lesion areas and polypoidal lesion areas tend to be larger in eyes with increasing SFCT. Choroidal background may influence the phenotype or progression pattern of PCV.

Polypoidal Choroidal Vasculopathy: Consensus Nomenclature and Non–Indocyanine Green Angiograph Diagnostic Criteria from the Asia-Pacific Ocular Imaging Society PCV Workgroup

To develop consensus terminology in the setting of polypoidal choroidal vasculopathy (PCV) and to develop and validate a set of diagnostic criteria not requiring indocyanine green angiography (ICGA) for differentiating PCV from typical neovascular age-related macular degeneration (nAMD) based on a combination of OCT and color fundus photography findings. Evaluation of diagnostic test results. Panel of retina specialists. As part of the Asia-Pacific Ocular Imaging Society, an international group of experts surveyed and discussed the published literature regarding the current nomenclature and lesion components for PCV, and proposed an updated consensus nomenclature that reflects our latest understanding based on imaging and histologic reports. The workgroup evaluated a set of diagnostic features based on OCT images and color fundus photographs for PCV that may distinguish it from typical nAMD and assessed the performance of individual and combinations of these non-ICGA features, aiming to propose a new set of diagnostic criteria that does not require the use of ICGA. The final recommendation was validated in 80 eyes from 2 additional cohorts. Consensus nomenclature system for PCV lesion components and non-ICGA-based criteria to differentiate PCV from typical nAMD. The workgroup recommended the terms polypoidal lesion and branching neovascular network for the 2 key lesion components in PCV. For the diagnosis of PCV, the combination of 3 OCT-based major criteria (sub-retinal pigment epithelium [RPE] ring-like lesion, en face OCT complex RPE elevation, and sharp-peaked PED) achieved an area under the receiver operating characteristic curve of 0.90. Validation of this new scheme in a separate subset 80 eyes achieved an accuracy of 82%. We propose updated terminology for PCV lesion components that better reflects the nature of these lesions and is based on international consensus. A set of practical diagnostic criteria applied easily to spectral-domain OCT results can be used for diagnosing PCV with high accuracy in clinical settings in which ICGA is not performed routinely.

REDUCED VASCULAR DENSITY IN THE CHOROID AFTER TREATMENT WITH PHOTODYNAMIC THERAPY COMBINED WITH AFLIBERCEPT IN PATIENTS WITH POLYPOIDAL CHOROIDAL VASCULOPATHY.

To investigate changes of vascular density in the choroid of patients with polypoidal choroidal vasculopathy treated with photodynamic therapy (PDT) combined with intravitreal aflibercept. This study examined 12 eyes of 12 patients, who were diagnosed as polypoidal choroidal vasculopathy. All patents underwent optical coherence tomography before and at 3 months after PDT combined with intravitreal aflibercept treatment. Using en face optical coherence tomography images, we analyzed vascular density of the area outside the polypoidal choroidal vasculopathy lesion and within the PDT exposure area at the level of the choriocapillaris and middle layer of the choroid. In the outer layer of the choroid, the thickest vessel was selected in the area exposed to PDT, with the diameter of the vessel analyzed. The vascular density in the choriocapillaris and middle layer of the choroid significantly decreased from 0.54 ± 0.09 before treatment to 0.44 ± 0.07 after PDT treatment in the choriocapillaris and from 0.53 ± 0.10 to 0.47 ± 0.08 in the middle layer of the choroid, respectively. There was also a significant reduction in the diameter of the largest vessel from 309 ± 85 µm at baseline to 220 ± 52 µm. Photodynamic therapy may cause occlusion of the choriocapillaris and middle vessels in the choroid, as well as stenosis of the large vessels.

Lateral elongation of flat irregular pigment epithelial detachment: A novel optical coherence tomography biomarker in polypoidal choroidal vasculopathy.

Purpose:To explore novel Optical Coherence Tomography (OCT) biomarkers and precursor lesions in Polypoidal Choroidal Vasculopathy (PCV).Methods:This retrospective cohort study included 76 treatment naïve fellow eyes of PCV. Focus was given to analyse the various morphological changes in the clinically unaffected fellow retina during the follow-up period.Results:11 fellow eyes (14.47%) developed disease activity in the form of Sub Retinal Fluid (SRF) or Intra Retinal Fluid (IRF) within a mean follow-up of 17 months. All 11 eyes (100%) showed the presence of flat irregular pigment epithelial detachment (FIPED) and a peculiar property of lateral elongation of FIPED during disease activity. A positive correlation with the disease progression was found for the same (P < 0.0001). The mean horizontal dimension of the flat irregular PED at the enrolment was 1984 ± 376u and the mean expansion of FIPED at SRF formation was 461 ± 152u. ICG taken at the time of disease activity in the fellow eye revealed branching vascular network (BVN) in 9 (81.8%) eyes, polyps in 7 (63.6%) eyes, a combination of both in 5 (45.4%) eyes. Type one BVN with interconnecting channels showed faster disease progression than type two BVN. Eye tracking ICG illustrated that BVN corresponded to the FIPED in OCT and polypoidal lesions developed at the end of expanding FIPED.Conclusion:Flat irregular pigment epithelial detachment with its characteristic property of lateral elongation may be considered as a precursor lesion for PCV and as a novel OCT biomarker for the disease activity. Fellow eyes with FIPED need close monitoring to identify development of disease activity at the earliest.

Age-Related Scattered Hypofluorescent Spots on Late-Phase Indocyanine Green Angiography as Precursor Lesions of Polypoidal Choroidal Vasculopathy.

Age-related scattered hypofluorescent spots on late-phase indocyanine green angiography (ASHS-LIA) might represent lipid accumulation in Bruch's membrane in the form of basal linear deposits (BlinD). The present study was conducted to describe the clinical characteristics of polypoidal choroidal vasculopathy (PCV) associated with ASHS-LIA. Consecutive patients with treatment-naïve PCV who underwent color fundus photography (FP), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and spectral-domain optical coherence tomography (SD-OCT) at the Zhongshan Ophthalmic Center from June 2016 through May 2018, were reviewed. ASHS-LIA and choroidal vascular hyperpermeability (CVH) were evaluated by ICGA. Subfoveal choroidal thickness (SFCT) was assessed by SD-OCT. A total of 187 patients were eligible for inclusion in this study (mean, 63.2 ± 7.6 years; range, 41-85 years). Of these patients, 117 (62.6%) showed ASHS-LIA, 57 (30.5%) had bilateral lesions and 70 (37.4%) showed CVH. Moreover, compared with patients without ASHS-LIA, PCV patients with ASHS-LIA were older (P = 0.001), more frequently had bilateral lesions (P = 0.001), and less frequently showed CVH (P = 0.006). SFCT in eyes with ASHS-LIA was significantly greater than that in eyes without ASHS-LIA after adjusting for age, sex, and CVH (P = 0.026). Nevertheless, there was no significant difference in best-corrected visual acuity or lesion characteristics between the two groups. ASHS-LIA, which is very common in PCV patients, might be involved in the pathogenesis of PCV. PCV with ASHS-LIA was more frequently associated with bilateral involvement, less CVH, and a thicker choroid than PCV without ASHS-LIA.

Different imaging characteristics between unilateral and bilateral polypoidal choroidal vasculopathy.

To investigate the different imaging characteristics between unilateral and bilateral polypoidal choroidal vasculopathy (PCV) cases, based on confocal scanning laser ophthalmoscope assessment. For this retrospective case series study, diagnostic indocyanine green angiography (ICGA) and spectral domain optical coherence tomography (SD-OCT) were performed to assess the eligible PCV eyes. Among the 53 patients at baseline, 14 showed bilateral PCV lesions, including two cases of branching vessel network (BVN) without leakage. Concerning the subfoveal choroidal thickness (SFCT), unilateral PCV eyes (326 [155-547] μm) were statistically comparable to their fellow eyes (330 [163-477] μm) (p = 0.257). However, the SFCT (228[141-273] μm) from the bilateral PCV group was significantly lower compared with both the PCV (p = 0.002) and fellow eyes (p < 0.001) from the unilateral group. Moreover, ICGA related hyperfluorescent spots were shown to have a significant positive correlation with SFCT in the unilateral PCV eyes and their fellow eyes, other than bilateral PCV cases. In addition, the drusens tended to prevail in the fellow eyes of the unilateral PCV group (46.2%), compared with bilateral cases. Our results indicate that SFCT, ICGA related hyperfluorescent spots, and drusen were the three main imaging characteristic differences between unilateral and bilateral PCV cases.

Multicolor Fundus Imaging of Polypoidal Choroidal Vasculopathy

Polypoidal choroidal vasculopathy (PCV) is a variant of neovascular age-related macular degeneration with distinct phenotypes, treatment, and visual prognosis. Multicolor imaging is a novel noninvasive imaging method that enables visualization of structures located at different layers of the retina and may be useful in detecting features of diseases. The features of PCV seen on multicolor imaging have not been studied. We aimed to describe the features of PCV detected using multicolor imaging and to compare these with standard color fundus photography (CFP). Hospital-based, cross-sectional study. Fifty consecutive treatment-naive patients diagnosed with PCV seen in a tertiary referral center. Multimodal imaging was performed using standardized protocols, and included CFP, multicolor imaging, fluorescein angiography, and indocyanine green angiography (ICGA). The CFP and ICGA images were independently graded by reading center-certified retinal specialists to confirm the diagnosis of PCV and identify lesion components. The features of the lesion components seen on multicolor images were compared with those detected using CFP and ICGA. Frequency and features of lesions associated with PCV, specifically, polyps, branching vascular network (BVN), pigment epithelial detachments (PEDs), hemorrhages, and drusen. The mean age of the 50 participants was 67.9 years, and 60% were male. Polyps were most clearly seen on the infrared reflectance image and detected in 49 of 50 eyes (98%), appearing as dark gray oval lesions with distinct margins. On the multicolor composite images, polyps appeared as dark green oval lesions. The BVN appeared as mottled gray regions on infrared reflectance imaging and were seen less frequently compared with polyps (30/50 eyes, 60%). The margins of the BVN were less distinct compared with polyps. Other clinical features detected using multicolor imaging included PEDs (26%), subretinal hemorrhages (40%), and drusen (66%). Multicolor imaging is able to detect polypoidal lesions in most patients with PCV. The appearance of PCV lesions on multicolor imaging differs from standard CFP, although the location and shape of lesions correlate well with features seen on CFP and ICGA. Multicolor imaging is a useful, noninvasive adjunct to detect features suggestive of PCV, which may prompt definitive investigations such as ICGA.

Optic disk melanocytoma associated with polypoidal choroidal vasculopathy lesions, after combination treatment of photodynamic therapy and intavitreal aflibercept (Eylea), a case report

BackgroundWe report a rare case of a woman with optic disk melanocytoma (ODMC) in conjunction with polypoidal choroidal vasculopathy (PCV). We also present, for the first time in literature, the clinical and morphological outcomes of the applied treatment, consisting of a session of photodynamic therapy (PDT) and three monthly intravitreal aflibercept injections.Case presentationAn 83-year-old Greek woman, complaining for visual decline at her left eye, referred to our department and was diagnosed with ODMC associated with PCV. At presentation, best corrected visual acuity (BCVA) was 2/10, fundus examination revealed a pigmented lesion covering partially the optic nerve head and extending into the peripapillary choroid and retina, while hard exudates were observed temporal to it. Blocked hypofluorescence in the area covered by the lesion and diffuse hyperfluorescence at its temporal rim were shown by fluorescein angiography (FA). Indocyanine green angiography (ICGA) identified 3 hyperfluorescent polypoidal lesions arising from the choroidal vasculature. Optical coherence tomography (OCT) revealed subretinal fluid and retinal pigment epithelium detachment (RPE) at the region corresponding to polyps. The treatment included a PDT session combined with 3 monthly intravitreal aflibercept injections. Three months since the treatment initiation, new BCVA was 5/10, ICGA demonstrated total polyps occlusion, while OCT detected RPE detachment without subretinal fluid. Ten months later, ODMC was stable, BCVA rose to 7/10, no polyps were present, and total resolution of RPE detachment was achieved.ConclusionsThis is the first case report of PCV coexisting with ODMC, presenting both ICGA and OCT findings, and the applied treatment and its outcomes. Furthermore, we demonstrated that PDT combined with intravitreal aflibercept injections seems to be a promising treatment for PCV.

Indocyanine Green Dye Filling Time for Polypoidal Lesions in Polypoidal Choroidal Vasculopathy Affects the Visibility of the Lesions on OCT Angiography

To elucidate the factors that affect the visibility of polypoidal lesions on OCT angiography (OCTA) based on indocyanine green angiography (ICGA) findings in eyes with polypoidal choroidal vasculopathy (PCV). Retrospective, consecutive case series. Thirty-one eyes of 31 patients with PCV diagnosed on ICGA. We compared the numbers of polyps visible on ICGA and on OCTA. The following time points and durations were determined: first appearance of dye in the choroidal arteries, first appearance of dye within a polyp, and the time it took the dye to fill entire lesions. Then we compared visible and invisible polyps on OCTA in these respects. The visibility of polypoidal lessons on OCTA and, in relation to this, the time it took the indocyanine green dye to fill the polypoidal lesions. The total number of polyps detected on ICGA was 62, and 49 of these (79.0%) were imaged on OCTA. The time points determined were not significantly different, but elapsed time from the first appearance of the dye in the choroidal arteries to the first appearance of the dye within a polyp was significantly longer for the polyps that were not detected on OCTA than for those that were (5.15±2.30 seconds vs. 2.08±1.08 seconds; P < 0.001). The visibility of polyps on OCTA decreases when blood flow is slower as manifested by a longer choroid-to-polyp dye infusion time on ICGA.

Polypoidal choroidal vasculopathy: Pearls in diagnosis and management.

Polypoidal choroidal vasculopathy (PCV) is increasingly recognized as an important cause of exudative maculopathy in Asians as against Wet age-related macular degeneration in Caucasians. A panel of retinal experts methodically evaluated pertinent updated literature on PCV with thorough PubMed/MEDLINE search. Based on this, the panel agreed upon and proposed the current consensus recommendations in the diagnosis (clinical and imaging), management and follow-up schedule of PCV. Diagnosis of PCV should be based on the gold standard indocyanine green angiography which demonstrates early nodular hyperfluorescence signifying the polyp with additional features such as abnormal vascular network (AVN). Optical coherence tomography is an excellent adjuvant for diagnosing PCV, monitoring disease activity, and decision-making regarding the treatment. Current treatment modalities for PCV include photodynamic therapy, anti-vascular endothelial growth factor agents, and thermal laser. Choice of specific treatment modality and prognosis depends on multiple factors such as the location and size of PCV lesion, presence or absence of polyp with residual AVN, amount of submacular hemorrhage, presence or absence of leakage on fundus fluorescein angiography, visual acuity, and so on. Current recommendations would be invaluable for the treating physician in diagnosing PCV and in formulating the best possible individualized treatment strategy for optimal outcomes in PCV management.

All Types of Age-related Macular Degeneration in One Patient.

Herein, we describe a neovascular age-related macular degeneration patient with retinal angiomatous proliferation (RAP) and polypoidal choroidal vasculopathy (PCV) coexisting in the same eye at the time of diagnosis. A 55-year-old woman presented with a history of decreased vision in her left eye. Fundoscopy, fluorescein and indocyanine green angiography, and optical coherence tomography imaging revealed RAP and PCV lesions in her left eye at first diagnosis. The patient received intravitreal ranibizumab therapy but developed tachyphylaxis after the first dose despite having three monthly doses. Switching to intravitreal aflibercept injection in our case resulted in anatomic and functional improvement.

Changes of fundus autofluorescence in polypoidal choroidal vasculopathy before and after intravitreal ranibizumab injections

Objective To observe the characteristics of fundus autofluorescence (FAF) in patients with polypoidal choroidal vasculopathy (PCV) before and after intravitreal ranibizumab injections. Methods A retrospective case series. Seventeen patients (17 eyes) including 11 males and 6 females were enrolled in this study. Best corrected visual acuity (BCVA), FAF and indocyanine green angiography examination were performed on all eyes. The eyes were divided into hypo-autofluorescence group (8 eyes) and mixed autofluorescence group (9 eyes) according to the fluorescence degree. There was no differences of BCVA between two groups (t=2.403, P=0.072).All eyes received monthly intravitreal ranibizumab injections for 3 months followed by an as-needed reinjection schedule. All eyes were followed up for 12 months. FAF was performed at the 3rd, 6th and 12th month after first treatment. The changes of FAF characteristics and BCVA before and after treatment were observed. Results Before the treatment, the PCV lesions showed two distinct FAF patterns: the confluent hypo-autofluorescence at the polypoidal lesions and the granular hypo-auto fluorescence at branching choroidal vascular networks (BVN). During the treatment, the abnormal FAF area of the whole lesions in all eyes reduced and gradually returned to normal. At the 3rd month after treatment, the central hypo-autofluorescence of polyps was surrounded by a hyper-auto fluorescence ring, and with time, the ring was weakened or eliminated. However, all the hypo-autofluorescence findings in BVN at baseline were unchanged during the follow-up period. There was no significant differences in BCVA between hypo-auto fluorescence group and hyper-autofluorescence group at different follow-up times (t=2.674, 2.862, 2.250; P=0.058, 0.052, 0.081). At final follow-up, 5 eyes (62.5%) in hypo-auto fluorescence group and 3 eyes (33.3%) in hyper-auto fluorescence group had increased BCVA, the different was not significant (P=0.347). Conclusions Before the treatment, there were the central hypo-autofluorescence of polyps and circumferential hypo-auto fluorescence ring or confluent hypo-autofluorescence. After the treatment, the auto fluorescence of polyps increased and then gradually returned to normal. Key words: Choroid diseases; Angiogenesis inhibitors; Ranibizumab