Relationship between Pachychoroid and Polypoidal Choroidal Vasculopathy

Abstract

Previous clinical studies have suggested that pachychoroid can induce macular neovascularization (MNV) to develop pachychoroid neovasculopathy (PNV) and that PNV can progress to polypoidal choroidal vasculopathy (PCV). Recent studies based on the pachychoroid concept are now gradually revealing the true nature of, at least some part of, PCV. However, previous studies on PNV and/or PCV have used different frameworks for the classification of PNV, PCV, and neovascular age-related macular degeneration (nAMD). These have hampered the rapid overhaul of the understanding of PCV. Some investigators have assumed that all PCV is pachychoroid-driven whereas other investigators have classified PCV into “pachychoroid PCV” and “non-pachychoroid PCV”. Furthermore, since there is no consensus as to whether PNV includes PCV, some studies have included PCV with PNV, while other studies have excluded PCV from PNV. To address these gaps, we summarize previous studies on PCV and pachychoroid. Even before the proposal of the pachychoroid concept, previous studies had suggested that PCV could be divided into two subtypes, of which one was characterized by pachychoroid features. Previous studies had also provided keys to understand relationship between PCV and PNV. We here recommend a refined conceptual framework for future studies on PNV, PCV, and nAMD. Considering the current inconsistent understanding of PCV, we should be cautious about using the term PCV until we understand the true nature of PCV.

Analysis of Systemic and Serum Risk Factors in Patients with Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy

“…AMD is a heterogeneous disorder involving the complex interplay between aging, environmental risk factors, and genetic susceptibility [38,39]. PCV is suggested to belong to the pachychoroid spectrum of diseases, the pathogeneses of which might be associated with vortex veins or running patterns of choroidal vessels [40,41]. Despite the overlap of clinical or pathophysiological features, alterations in the levels of plasma markers appear to differ between nAMD and PCV [42][43][44][45].…”

Clinical implications of choroidal vascular brightness using ultra-widefield indocyanine green angiography in polypoidal choroidal vasculopathy

“…[17][18][19][20] Recent imaging studies have suggested that choroidal vascular hyperpermeability is followed by choriocapillaris atrophy and clinical manifestations such as RPE alteration and pigment epithelial detachment. 8, 21 The area of choroidal vascular hyperpermeability usually overlaps with the region of the dilated vortex vein as seen on OCT images. [22][23][24][25] This area of choroidal hypercyanescence includes not only dilated choroidal vessels, but also dye leakage on conventional ICGA.…”

Clinical implications of choroidal vascular brightness using ultra-widefield indocyanine green angiography in polypoidal choroidal vasculopathy

“…Recent imaging studies have suggested that choroidal vascular hyperpermeability is followed by choriocapillaris atrophy and clinical manifestations such as RPE alteration and pigment epithelial detachment 8,21 . The area of choroidal vascular hyperpermeability usually overlaps with the region of the dilated vortex vein as seen on OCT images [22][23][24][25] .…”