Pigment Epithelial Detachment in Polypoidal Choroidal Vasculopathy

doi:10.1016/j.ajo.2006.08.025

American Journal of Ophthalmology

Volume 143, Issue 1, January 2007, Pages 102-111.e1

https://doi.org/10.1016/j.ajo.2006.08.025 Get rights and content

Purpose

To study the morphological features of serosanguineous pigment epithelial detachments (PEDs) with accompanying polypoidal lesions in eyes with polypoidal choroidal vasculopathy (PCV).

Design

Retrospective observational case series.

Methods

For this observational case study, we retrospectively reviewed 93 consecutive eyes of 85 patients with PCV. The lesions in eyes with PCV were examined with indocyanine green angiography (IA) and optical coherence tomography (OCT).

Results

Of 93 eyes with PCV, 51 eyes (55%) had serous or hemorrhagic PEDs. Of these 51 eyes, a notch in the PED was found in 27 eyes (53%) by angiography, most of which showed polypoidal lesions by IA that corresponded in location to the notch observed by angiography. Polypoidal lesions were detected outside the PED in one eye (2%), at the margin of the PED in 33 eyes (65%), and inside the PED in 12 eyes (24%). OCT revealed that PED had a notch observed tomographically in 29 eyes (57%), most of which corresponded in location to polypoidal lesions seen by IA. In eight eyes, polypoidal lesions, which were adherent to the inner surface of the serous PED, appeared to be detached from the Bruch membrane and the choroid.

Conclusions

Polypoidal lesions are located at the margin of PED and make a notch in the accompanying PED that is visible by angiography and tomographically. When the polypoidal lesions have increased exudate, the fluid from the lesions infiltrates under the polypoidal lesions themselves, which results in the lesions detaching from the Bruch membrane and appearing to be located inside the PED.

Section snippets

Methods

For this observational case study, we retrospectively reviewed 93 consecutive eyes of 85 patients with PCV who visited the Macular Service in Kyoto University Hospital, Kyoto, Japan, for the first time from April 2004 to October 2005. All patients underwent comprehensive ophthalmologic examination, including best-corrected visual acuity, intraocular pressure, indirect ophthalmoscopy, slit-lamp biomicroscopy with contact lens, and OCT examination. Two types of OCT (Stratus OCT3000, Carl Zeiss,

Results

In the current study, we examined 93 eyes of 85 patients (56 men and 29 women), ranging in age from 49 to 93 years (71.4 ± 8.7 years). All patients were Japanese. The visual acuity of eyes with PCV ranged from hand motion to 20/15 (median 20/50). In all eyes, IA showed polypoidal lesions, most of which were connecting to a branching vascular network. In 92 eyes (99%), reddish-orange nodules were seen by ophthalmoscopic examination; many of these nodules corresponded to the polypoidal lesions

Discussion

PCV is characterized by a branching vascular network terminating in polypoidal lesions3, 4, 5, 6, 7, 8, 9, 10 and is often accompanied by serous or hemorrhagic PEDs.2, 3, 4, 5, 6, 7, 8, 9, 11, 12, 13 In our patients, 55% of eyes with PCV had PED observed by angiography. Although many PEDs in eyes with PCV appear oval or round by angiography,7, 9 they often have a notch at the margin. In eyes with AMD, Gass³⁰ previously reported that a notched border of large serous PED is an important

Akitaka Tsujikawa, MD, is a graduate of the Kyoto University Graduate School of Medicine, Kyoto, Japan. He completed his ophthalmology residency at Kyoto University Hospital and a fellowship in ophthalmology at the Kurashiki Central Hospital in Japan. Following fellowship, he worked on the retinal microcirculation at the Kyoto University Graduate School of Medicine and on diabetic retinopathy at the Children’ Hospital in Boston, Massachusetts. Dr Tsujikawa currently specializes in macular

References (32)

A.P. Ciardella et al.
Polypoidal choroidal vasculopathy
Surv Ophthalmol
(2004)
M. Uyama et al.
Polypoidal choroidal vasculopathy: natural history
Am J Ophthalmol
(2002)
R.S. Moorthy et al.
Idiopathic polypoidal choroidal vasculopathy of the macula
Ophthalmology
(1998)
R.A. Costa et al.
Polypoidal choroidal vasculopathy: angiographic characterization of the network vascular elements and a new treatment paradigm
Prog Retin Eye Res
(2005)
M. Yuzawa et al.
A study of laser photocoagulation for polypoidal choroidal vasculopathy
Jpn J Ophthalmol
(2003)
L.A. Yannuzzi et al.
Polypoidal choroidal vasculopathy masquerading as central serous chorioretinopathy
Ophthalmology
(2000)
F. Shiraga et al.
Surgical treatment of submacular hemorrhage associated with idiopathic polypoidal choroidal vasculopathy
Am J Ophthalmol
(1999)
H. Iijima et al.
Optical coherence tomography of orange-red subretinal lesions in eyes with idiopathic polypoidal choroidal vasculopathy
Am J Ophthalmol
(2000)
H. Iijima et al.
Optical coherence tomography of idiopathic polypoidal choroidal vasculopathy
Am J Ophthalmol
(1999)
W.R. Green et al.
Pathologic features of senile macular degeneration
Ophthalmology
(1985)

L.A. Yannuzzi et al.

Idiopathic polypoidal choroidal vasculopathy (IPCV)

Retina

(1990)

R.F. Spaide et al.

Indocyanine green videoangiography of idiopathic polypoidal choroidal vasculopathy

Retina

(1995)

L.A. Yannuzzi et al.

The expanding clinical spectrum of idiopathic polypoidal choroidal vasculopathy

Arch Ophthalmol

(1997)

M. Yuzawa et al.

The origins of polypoidal choroidal vasculopathy

Br J Ophthalmol

(2005)

M. Uyama et al.

Idiopathic polypoidal choroidal vasculopathy in Japanese patients

Arch Ophthalmol

(1999)

L.A. Yannuzzi et al.

Polypoidal choroidal vasculopathy and neovascularized age-related macular degeneration

Arch Ophthalmol

(1999)

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Joint Multimodal Deep Learning-based Automatic Segmentation of Indocyanine Green Angiography and OCT Images for Assessment of Polypoidal Choroidal Vasculopathy Biomarkers
2023, Ophthalmology Science
To develop a fully-automatic hybrid algorithm to jointly segment and quantify biomarkers of polypoidal choroidal vasculopathy (PCV) on indocyanine green angiography (ICGA) and spectral domain-OCT (SD-OCT) images.
Evaluation of diagnostic test or technology.
Seventy-two participants with PCV enrolled in clinical studies at Singapore National Eye Center.
The dataset consisted of 2-dimensional (2-D) ICGA and 3-dimensional (3-D) SD-OCT images which were spatially registered and manually segmented by clinicians. A deep learning-based hybrid algorithm called PCV-Net was developed for automatic joint segmentation of biomarkers. The PCV-Net consisted of a 2-D segmentation branch for ICGA and 3-D segmentation branch for SD-OCT. We developed fusion attention modules to connect the 2-D and 3-D branches for effective use of the spatial correspondence between the imaging modalities by sharing learned features. We also used self-supervised pretraining and ensembling to further enhance the performance of the algorithm without the need for additional datasets. We compared the proposed PCV-Net to several alternative model variants.
The PCV-Net was evaluated based on the Dice similarity coefficient (DSC) of the segmentations and the Pearson’s correlation and absolute difference of the clinical measurements obtained from the segmentations. Manual grading was used as the gold standard.
The PCV-Net showed good performance compared to manual grading and alternative model variants based on both quantitative and qualitative analyses. Compared to the baseline variant, PCV-Net improved the DSC by 0.04 to 0.43 across the different biomarkers, increased the correlations, and decreased the absolute differences of clinical measurements of interest. Specifically, the largest average (mean ± standard error) DSC improvement was for intraretinal fluid, from 0.02 ± 0.00 (baseline variant) to 0.45 ± 0.06 (PCV-Net). In general, improving trends were observed across the model variants as more technical specifications were added, demonstrating the importance of each aspect of the proposed method.
The PCV-Net has the potential to aid clinicians in disease assessment and research to improve clinical understanding and management of PCV.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Polypoidal Choroidal Vasculopathy: Consensus Nomenclature and Non–Indocyanine Green Angiograph Diagnostic Criteria from the Asia-Pacific Ocular Imaging Society PCV Workgroup
2021, Ophthalmology
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.
Diagnostic and therapeutic approach to polypoidal choroidal vasculopathy. Recommendations of the France Macula Federation
2019, Journal Francais d'Ophtalmologie
Mettre à jour la littérature médicale sur l’approche diagnostique et thérapeutique de la vasculopathie polypoïdale choroïdienne (VPC) et proposer un algorithme de traitement adapté aux recommandations françaises et à la bonne utilisation des autorisations de mise sur le marché (AMM), soutenu par la Fédération France Macula (FFM).
Analyse de la littérature et avis d’experts.
Le diagnostic de la VPC repose sur l’imagerie multimodale, néanmoins, l’angiographie au vert d’indocyanine est recommandée par la FFM et reste le Gold Standard. Concernant la prise en charge thérapeutique de la VPC, la FFM recommande de traiter la VPC en 1ère intention soit par monothérapie avec des injections intra-vitréennes d’anti-VEGF, soit par traitement combiné associant photothérapie dynamique (PDT) à la Verteporfine et injections intra-vitréennes d’anti-VEGF en fonction de la localisation de la VPC.
To update the medical literature on the diagnostic and therapeutic approach to polypoidal choroidal vasculopathy (PCV) and to propose a treatment algorithm in agreement with French market approval, supported by the France Macula Federation (FFM).
Literature review and expert opinion.
The diagnosis of PCV is based on multimodal imaging, including indocyanine green angiography (ICGA), which is considered the gold standard for the diagnosis of PCV. Regarding the therapeutic management of PCV, the FFM recommends treating PCV first-line either by monotherapy with intra-vitreal anti-vascular endothelial growth factor (anti-VEGF) injections, or by a combined treatment of photodynamic therapy (PDT) with Verteporfin and intra-vitreal anti-VEGF injections, depending on the location of the PCV.
Comparison of Progression to Advanced Stage between Polypoidal Choroidal Vasculopathy and Age-Related Macular Degeneration in Korea
2018, Ophthalmology Retina
To compare the rate of progression to advanced stage in the fellow eye of patients with typical age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) in a South Korean cohort.
This is an observational, consecutive retrospective case series.
Patients with unilateral advanced stage AMD (n = 288; 180 typical AMD patients and 108 PCV patients).
Clinical assessment included detailed eye examination, including fundus photography, fluorescein angiography, and indocyanine green angiography.
Five-year progression rate to advanced stage in the fellow eye based on initial Age-Related Eye Disease Study (AREDS) score and the correlation between the initial AREDS score and progression to advanced disease in the fellow eye according to types of AMD.
Five-year progression to advanced disease in the fellow eye was similar between typical AMD and PCV cases (11.1% vs. 14.8 %, respectively; P = 0.466, log-rank test). Among patients with initial AREDS score of 2 (normal macula or small drusen on the fellow eye), a higher proportion of patients progressed to advanced disease in the PCV group compared with typical AMD patients (10.4% vs. 2.4 %, respectively; P = 0.0042, log-rank test). Initial AREDS score correlated significantly with progression of the fellow eye to advanced stage in the typical AMD group, after adjusting for age, gender, and other comorbidities (hazard ratio [HR], 9.5; 95% confidence interval [CI], 2.80–32.12; P = 0.0003). However in the PCV group, initial AREDS score did not correlate with progression to advanced stage in the fellow eye (HR, 1.84; 95% CI, 0.83–4.05; P = 0.13).
Unlike typical AMD, PCV progresses without typical features such as drusen or pigmentary abnormality. Baseline AREDS score was less likely to predict progression of the fellow eye to advanced-stage disease in PCV compared with typical AMD. Therefore, the globally recognized risk-scoring AREDS system may not be applicable in Asia, where PCV is a prevalent subtype of AMD.
Polypoidal Choroidal Vasculopathy: Definition, Pathogenesis, Diagnosis, and Management
2018, Ophthalmology
Polypoidal choroidal vasculopathy (PCV) is an age-related macular degeneration (AMD) subtype and is seen particularly in Asians. Previous studies have suggested disparity in response to intravitreal injections of anti–vascular endothelial growth factor (VEGF) agents between PCV and typical AMD, and thus, the preferred treatment for PCV has remained unclear. Recent research has provided novel insights into the pathogenesis of PCV, and imaging studies based on OCT suggest that PCV belongs to a spectrum of conditions characterized by pachychoroid, in which disturbance in the choroidal circulation seems to be central to its pathogenesis. Advances in imaging, including enhanced depth imaging, swept-source OCT, en face OCT, and OCT angiography, have facilitated the diagnosis of PCV. Importantly, 2 large, multicenter randomized clinical trials evaluating the safety and efficacy of anti-VEGF monotherapy and combination with photodynamic therapy (PDT) recently reported initial first-year outcomes, providing level I evidence to guide clinicians in choosing the most appropriate therapy for PCV. In this review, we summarize the latest updates in the epidemiologic features, pathogenesis, and advances in imaging and treatment trials, with a focus on the most recent key clinical trials. Finally, we propose current management guidelines and recommendations to help clinicians manage patients with PCV. Remaining gaps in current understanding of PCV, such as significance of polyp closure, high recurrence rate, and heterogeneity within PCV, are highlighted where further research is needed.
Intravitreal Brolucizumab and Aflibercept for Polypoidal Choroidal Vasculopathy
2023, Journal of Ocular Pharmacology and Therapeutics

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Original articlePigment Epithelial Detachment in Polypoidal Choroidal Vasculopathy

Purpose

Design

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Surv Ophthalmol

Am J Ophthalmol

Ophthalmology

Prog Retin Eye Res

Jpn J Ophthalmol

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Idiopathic polypoidal choroidal vasculopathy (IPCV)

Retina

Indocyanine green videoangiography of idiopathic polypoidal choroidal vasculopathy

Retina

The expanding clinical spectrum of idiopathic polypoidal choroidal vasculopathy

Arch Ophthalmol

The origins of polypoidal choroidal vasculopathy

Br J Ophthalmol

Idiopathic polypoidal choroidal vasculopathy in Japanese patients

Arch Ophthalmol

Polypoidal choroidal vasculopathy and neovascularized age-related macular degeneration

Arch Ophthalmol

Original article
Pigment Epithelial Detachment in Polypoidal Choroidal Vasculopathy