A novel classification of the vascular patterns of polypoidal choroidal vasculopathy and its relation to clinical outcomes

• Published in: British journal of ophthalmology Vol. 98; no. 11; pp. 1528 - 1533
• Main Authors: Tan, Colin SH, Ngo, Wei Kiong, Lim, Louis W, Lim, Tock Han
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.11.2014
• Subjects: Adult; Aged; Aged, 80 and over; Choroidal Neovascularization - classification; Choroidal Neovascularization - drug therapy; Choroidal Neovascularization - physiopathology; Classification; Clinical outcomes; Coloring Agents; Female; Fluorescein Angiography; Humans; Indocyanine Green; Macular degeneration; Male; Medical imaging; Middle Aged; Multivariate analysis; Patients; Photochemotherapy; Photosensitizing Agents - therapeutic use; Polyps - classification; Polyps - drug therapy; Polyps - physiopathology; Porphyrins - therapeutic use; Retrospective Studies; Studies; Visual Acuity - physiology; Macula; Retina; Imaging
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjophthalmol-2014-305059

Purpose To propose a novel classification system for polypoidal choroidal vasculopathy (PCV), and compare the clinical outcomes among PCV subtypes. Methods Consecutive treatment-naive patients with symptomatic PCV were managed over 5 years. PCV subtypes were classified based on indocyanine green angiography (ICGA) and fluorescein angiography (FA) characteristics. Results Among 107 patients, 3 PCV subtypes were seen: Type A (interconnecting channels on ICGA) –22.4%; Type B (branching vascular network with no leakage) –24.3%; Type C (branching vascular network with late leakage on FA) –53.3%. The proportion of patients with best-corrected visual acuity (BCVA) ≥20/40 was highest in Type A, intermediate in Type B and lowest in Type C at all time points (80% vs 66.7% vs 7.7% at 5 years, p<0.001). The highest rate of moderate visual loss (loss of ≥3 lines) occurred in Type C PCV (57.7% vs 0% for Types B and A at 5 years, p<0.001). Risk factors for poor visual outcomes were PCV subtype (OR 53.7, p<0.001 for Type C and OR 13.7, p=0.023 for Type B compared to Type A) and age (OR 1.06, 95% CI 1.002 to 1.125, p=0.044). Conclusions The PCV subtype seen on initial presentation affects the long-term visual outcomes over a 5-year period.