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The origins of polypoidal choroidal vasculopathy
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  1. M Yuzawa,
  2. R Mori,
  3. A Kawamura
  1. Surugadai Hospital, Nihon University, 1-8-13 Surugadai, Kanda, Chiyoda-ku, Tokyo, Japan
  1. Correspondence to: Professor Mitsuko Yuzawa Surugadai Hospital, Nihon University, 1-8-13 Surugadai, Kanda, Chiyoda-ku, Tokyo, Japan; yuzawammed.nihon-u.ac.jp

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.

  • AMD, age related macular degeneration
  • CNV, choroidal neovascularisation
  • IGA, indocyanine green angiography
  • OCT, optical coherence tomography
  • PCV, polypoidal choroidal vasculopathy
  • RPE, retinal pigment epithelium
  • SLO, scanning laser ophthalmoscopy
  • confocal scanning laser ophthalmoscopy
  • high speed indocyanine green angiography
  • polypoidal choroidal vasculopathy
  • AMD, age related macular degeneration
  • CNV, choroidal neovascularisation
  • IGA, indocyanine green angiography
  • OCT, optical coherence tomography
  • PCV, polypoidal choroidal vasculopathy
  • RPE, retinal pigment epithelium
  • SLO, scanning laser ophthalmoscopy
  • confocal scanning laser ophthalmoscopy
  • high speed indocyanine green angiography
  • polypoidal choroidal vasculopathy
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