Polypoidal choroidal vasculopathy: Pearls in diagnosis and management

• Published in: Indian journal of ophthalmology Vol. 66; no. 7; pp. 896 - 908
• Main Authors: Anantharaman, Giridhar, Sheth, Jay, Bhende, Muna, Narayanan, Raja, Natarajan, Sundaram, Rajendran, Anand, Manayath, George, Sen, Parveen, Biswas, Rupak, Banker, Alay, Gupta, Charu
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.07.2018; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd; Wolters Kluwer Medknow Publications
• Subjects: Abnormal vascular network; Acuity; Age; Angiography; Asian people; Care and treatment; Decision making; Diagnosis; Ethnicity; Evaluation; Fluorescein; Hemorrhage; Hospitals; indocyanine green angiography; Lasers; Lipids; Macular degeneration; Management; Medical care quality; Medical imaging; Medical research; Ophthalmology; optical coherence tomography; Pearls; Photodynamic therapy; polypoidal choroidal vasculopathy; Population; Retina; Retinal diseases; Review; thermal laser; Vascular diseases; Vascular endothelial growth factor; White people; polypoidal choroidal vasculopathy; thermal laser; Abnormal vascular network; indocyanine green angiography; optical coherence tomography; photodynamic therapy
• ISSN: 0301-4738; 1998-3689
• DOI: 10.4103/ijo.IJO_1136_17

Polypoidal choroidal vasculopathy (PCV) is increasingly recognized as an important cause of exudative maculopathy in Asians as against Wet age-related macular degeneration in Caucasians. A panel of retinal experts methodically evaluated pertinent updated literature on PCV with thorough PubMed/MEDLINE search. Based on this, the panel agreed upon and proposed the current consensus recommendations in the diagnosis (clinical and imaging), management and follow-up schedule of PCV. Diagnosis of PCV should be based on the gold standard indocyanine green angiography which demonstrates early nodular hyperfluorescence signifying the polyp with additional features such as abnormal vascular network (AVN). Optical coherence tomography is an excellent adjuvant for diagnosing PCV, monitoring disease activity, and decision-making regarding the treatment. Current treatment modalities for PCV include photodynamic therapy, anti-vascular endothelial growth factor agents, and thermal laser. Choice of specific treatment modality and prognosis depends on multiple factors such as the location and size of PCV lesion, presence or absence of polyp with residual AVN, amount of submacular hemorrhage, presence or absence of leakage on fundus fluorescein angiography, visual acuity, and so on. Current recommendations would be invaluable for the treating physician in diagnosing PCV and in formulating the best possible individualized treatment strategy for optimal outcomes in PCV management.