Polypoidal choroidal vasculopathy: an angiographic discussion

• Published in: Eye (London) Vol. 24; no. 3; pp. 483 - 490
• Main Authors: Lim, T H, Laude, A, Tan, C S H
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.03.2010; Nature Publishing Group
• Subjects: 631/378/1689/1626; 692/700/139; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Biological and medical sciences; cambridge-ophthalmological-symposium; Cardiovascular system; Choroid - blood supply; Choroid Diseases - diagnosis; Choroid Diseases - drug therapy; Choroid Diseases - pathology; Diseases of the skin. Cosmetics; Fluorescein Angiography; Humans; Immunologic Factors - therapeutic use; Indocyanine Green - therapeutic use; Investigative techniques, diagnostic techniques (general aspects); Laboratory Medicine; Macular Degeneration - drug therapy; Macular Degeneration - pathology; Medical sciences; Medicine; Medicine & Public Health; Miscellaneous; Ophthalmology; Peripheral Vascular Diseases - diagnosis; Peripheral Vascular Diseases - drug therapy; Peripheral Vascular Diseases - pathology; Pharmaceutical Sciences/Technology; Photochemotherapy - methods; Polyps - diagnosis; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Ranibizumab; Retina - pathology; Retinopathies; Surgery; Surgical Oncology; Vascular Endothelial Growth Factors - antagonists & inhibitors; polypoidal choroidal vasculopathy; indocyanine green angiography; fluorescein angiography; age-related macular degeneration; branching vascular network; photodynamic therapy; Branching; Polypoidal choroidal vasculopathy; Retinopathy; Photodynamic therapy; Radiodiagnosis; Angiography; Indocyanine green; Eye disease; Treatment; Blood vessel; Fluorescein; Network; Age related macular degeneration; Ophthalmology
• ISSN: 0950-222X; 1476-5454
• DOI: 10.1038/eye.2009.323

The understanding of polypoidal choroidal vasculopathy has evolved rapidly in the past three decades. The hallmark of the disease is the presence of typical hyperfluorescent nodules in the early phase of indocyanine green angiography. Although the classical clinical presentation is recurrent serosanguinous detachment of the retinal pigment epithelium, it may present with clinical features indistinguishable from exudative age-related macular degeneration secondary to choroidal neovascularization. Some cases may present initially with submacular haemorrhage, but later with features of exudative age-related macular degeneration. Studying the associated network of vessels using confocal scanning laser ophthalmoscopy indocyanine green dynamic angiography revealed in many cases feeder vessels, branching pattern, and leakage similar to choroidal neovascularization. Owing to the overlap of clinical and angiographic features, it may be considered as a vascular subtype of exudative age-related macular degeneration. However, having seemingly better natural history, better response to photodynamic therapy, and incomplete response to anti-vascular endothelial growth factor therapy suggests that it should be studied as a separate entity from choroidal neovascularization. Combining angio-occlusion of the polyps using photodynamic therapy and anti-permeability effect of anti-vascular endothelial growth factor therapy on the branching vascular network may provide a synergistic effect. We await the result of EVEREST trial, a multi-centre randomized controlled trial comparing photodynamic therapy, with or without ranibizumab, with ranibizumab monotherapy.