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Polypoidal choroidal vasculopathy appearing as classic choroidal neovascularisation on fluorescein angiography

Hiroshi Tamura, Akitaka Tsujikawa, Atsushi Otani, Norimoto Gotoh, Manabu Sasahara, Takanori Kameda, Daisuke Iwama, Yuko Yodoi, Michiko Mandai and Nagahisa Yoshimura

Department of Ophthalmology, Kyoto University Graduate School of Medicine, Kyoto, Japan

Correspondence to:
Dr H Tamura, Department of Ophthalmology, Kyoto University Graduate School of Medicine, Shogoin-Kawahra-cho 54 Sakyo, Kyoto 606–8507, Japan; htamura-kyt{at}umin.ac.jp

Aims: To study the visual prognosis and ocular characteristics of eyes with polypoidal choroidal vasculopathy (PCV) that appear to have classic choroidal neovascularisation (CNV) on fluorescein angiography (FA).

Methods: The authors reviewed retrospectively 38 eyes with PCV that appear to have classic CNV on FA. Lesions were examined with indocyanine green angiography, FA and optical coherence tomography (OCT).

Results: In all cases OCT showed subretinal material with moderate reflectivity that corresponded in location to classic CNV. At the final visit, the subretinal material resolved completely in 14 eyes (36.8%, resolved group), but resolved only incompletely in 24 eyes (63.2%, persisted group) after photodynamic therapy (PDT). Mean (standard deviation) visual acuity in the resolved group (0.35 (0.41) in log MAR) was significantly better than that in the persisted group (0.84 (0.24)) at the final visit (p<0.001). The subretinal material seen before treatment was more frequently seen in subfovea in the persisted group (87.5% vs 42.9%, p = 0.007). Also, this material was located adjacent to polypoidal lesions more often in the resolved group (92.9% vs 58.3%, p = 0.030).

Conclusions: Eyes with PCV sometimes show classic CNV with subretinal material apparent on OCT, and PCV is thus attributed to type 2 CNV or to pure fibrinous tissue without CNV. Visual prognosis in eyes with type 2 CNV is poor, and although it is difficult to discriminate type 2 CNV from pure fibrin deposition before treatment, type 2 CNV is seen more often in the subfovea and is typically separate from the polypoidal lesions.

Abbreviations: CNV, choroidal neovascularisation; FA, fluorescein angiography; OCT, optical coherence tomography; PCV, polypoidal choroidal vasculopathy; PDT, photodynamic therapy; RPE, retinal pigment epithelium

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