Good Hope Eye Clinic

Polypoidal choroidal vasculopathy wet ARMD

David Kinshuck

 

 

Polypoidal choroidal vasculopathy

This is another type of CNV. The condition is seen as a branching choroidal network of vessels with vascular dilatation.

  • more common in Chinese and Afro-Caribbeans.
  • The choroidal neovascularisation often occurs with a serous haemorrhagic PED.  
  • Polypoidal choroidal vasculopathy page.   
  • multiple PEDS, subretinal haemorrhages, visible polyps: deep orange lesions
  • lipid exudates, subretinal fluid, RPE atrophy, peripapillary lesions
  • classic & occult cnv, peripheral lesions: Features see
  • distinguishing polypoidal choroidal vasculopathy from typical neovascular age-related macular degeneration based on spectral domain optical coherence tomography Retina16
  • Wilki
  • type 1 and type 2 IOVS

Features of PCV, after Yang 2012

 

  • really need ICG
  • features vascular and secondary components
  • Vascular
    • nodular choroidal lesions
    • branching vascular networks
    • associated classic/occult CNV
  • Secondary features:
    • serous PED
    • subretinal haemorrhage
    • preretinal haemorrhage
    • haemorrhagic PED
    • lipid exudation
    • SRF
    • CSR
    • fibrosis  and atrophy

 

PCV paper...look for the polyps

look for the polpyps...the white blobs

 

 

BJO diagram PCV features

 

Look for the polyps and branching vascular network (BVN)

Look for polyps on the ICG, or suspect the condition if the features above are present. On the ICG, the polyps occur on a local dark patch on the ICG. Also, look for the feeding branching vascular network (BVN). The polyps occur in nodules, loops, or coils. The polyps show up late at 4 minutes on the ICG. It may be the BVN is simply CNV confined to one retinal layer.

 

close up of PCV with its BVN  (from photo above)

the arrow points to the BVN, the white blobs are the polyps (ICG photo)

 

cot diagram of pcv findings

look for the notch and the polyps

polyps and branching vascular network in PCV

polyps and branching vascular network (BVN) in PCV

 

polypoidalcnv

 

Haemorrhagic PEDs

haemorhagic PED...typical of pcv

haemorrhagic PED..typical of PCV

66% of these are due to PCV (the remainder are due to other types of CNV (wet ARMD). Peripheral Retina 2013.

With vitreous haemorrhage Eye 14

 

 

 

Everest Study & treatment

  • Retina 2102 this confirms that PDT and anti-VEGF treatment is 70% effective for PCV
  • Anti-VEGF alone closes 30%
  • anti-VEGF helps Retina 2013
  • treat and extend Retina17

Some notes