The origins of polypoidal choroidal vasculopathy

Abstract

Background/aim: There are two theories on the pathogenesis of polypoidal choroidal vasculopathy (PCV): variants in choroidal neovascularisation (CNV) and inner choroidal vessel abnormalities. On indocyanine green angiography (IGA) with a video camera system, PCV has a characteristic appearance, but inadequate image quality has made detailed interpretation difficult. This study aims to improve imaging, using confocal scanning laser ophthalmoscopy (SLO), to elucidate the pathogenesis of PCV. Methods: High speed IGA with confocal SLO of 45 eyes (44 patients) showed typical PCV findings of a branching vascular network and polypoidal lesions. Results: Vessels comprising branching networks began to fill simultaneously with the surrounding choroidal arteries in 38 eyes. Small numbers of vessels filling within a branching network, in the arterial and arteriovenous phases of IGA, showed focal dilatation, constriction, and tortuousity. Vessel abnormalities, corresponding to polypoidal lesions, existed within a network in eight eyes and included loops similar in calibre to network vessels, and numerous microaneurysmal dilatations of small vessels. Vessel pulsation was seen in 24 eyes. Conclusion: PCV is caused by inner choroidal vessel abnormalities, not CNV.

Outcome of polypoidal choroidal vasculopathy at 1 year by combined therapy of photodynamic therapy with ranibizumab and predictive factors governing the outcome

“…It was based on disease characteristics of elevated orange-red lesions (not resembling a PED, choroidal hemangioma, or subretinal blood) on clinical examination or characteristic polypoidal vasculature on ICGA. 9 Exclusion criteria included previous history of AMD, history of PDT, a high myopia (of 46 D) and pre-existing macular scar.…”

Polypoidal Choroidal Vasculopathy: Clinical Features and Genetic Predisposition

“…In ICGA, PCV is typically characterized by distinct forms of choroidal vascular abnormalities, including characteristic polypoidal lesions with or without branching vascular networks (BVNs) of choroidal origin [50]. As described above, polyp lesions are mostly present at the margin and inside the PED, which may cause a ‘notch sign' between the PED, including polyp lesions and connecting PED, which includes the BVN.…”

Polypoidal choroidal vasculopathy: an angiographic discussion

“…Studying CSLO-ICGA, Yuzawa et al 39 observed that in some cases the BVN showed pulsatile flow, suggesting that they emanate from inner choroidal arterioles. The authors concluded that there may be two types of BVN, one represents intra-choroidal vascular abnormality ('PCV in the narrow sense'), the other represents neovascularization ('polypoidal CNV') that grows rapidly in the sub-RPE space.…”