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Polypoidal choroidal vasculopathy
Antonio P Ciardella1, Irene M Donsoff, Lawrence A Yannuzzi
1LuEsther T. Mertz Retinal Research Laboratory, Manhattan Eye, Ear and Throat Hospital, 210 East 64th Street, New York, NY 10021, USA. aciardella@yahoo.com
Insights
Polypoidal choroidal vasculopathy (PCV) is a distinct condition with unique vascular abnormalities. Diagnosis via ICG angiography is crucial for guiding conservative management, with photodynamic therapy showing promise but requiring further trials.
Area of Science:
- Ophthalmology
- Vascular Biology
Background:
- Polypoidal choroidal vasculopathy (PCV) presents unique vascular abnormalities.
- Differentiating PCV from other choroidal vascular conditions, such as age-related macular degeneration (AMD)-associated choroidal neovascularization (CNV), is clinically significant.
Purpose of the Study:
- To highlight the distinct clinical entity of PCV.
- To emphasize the diagnostic utility of indocyanine green (ICG) angiography in identifying characteristic PCV vascular lesions.
- To discuss management strategies for PCV, including conservative approaches and potential therapeutic interventions.
Main Methods:
- Clinical observation and diagnostic evaluation of patients with suspected PCV.
- Utilizing indocyanine green (ICG) angiography to visualize choroidal vascular abnormalities.
- Review of existing literature on PCV diagnosis and management.
Main Results:
- PCV is characterized by a branching vascular network and polypoidal structures at lesion borders.
- ICG angiography is essential for diagnosing PCV, especially in patients with serosanguineous pigment epithelial detachment and risk factors (e.g., African American or Asian race).
- A conservative management approach is generally recommended unless central macula threat necessitates intervention.
Conclusions:
- PCV is a distinct clinical entity requiring differentiation from other CNV types.
- ICG angiography is key for definitive PCV diagnosis.
- While conservative management is preferred, selective photocoagulation or photodynamic therapy (PDT) may be considered for specific indications, pending further clinical trials on PDT efficacy and safety.
Abstract:
Polypoidal choroidal vasculopathy seems to be a distinct clinical entity that should be differentiated from other types of CNV associated with AMD and other known choroidal degenerative, inflammatory, and ischemic disorders. The principle abnormality seen in PCV, notably the branching vascular network and polypoidal structures at the borders of the lesion, seem to be unique to the disorder. In patients with serosanguineous detachment of the pigment epithelium, particularly in those with increased risk factors such as African American or Asian race, ICG should be performed to evaluate the choroidal vascular abnormality to establish a more definitive diagnosis. If the characteristic vascular lesion of PCV is seen, a conservative approach to management should be taken unless there is a persistent or progressive exudative change that threatens the central macula. In that event, there may be a rationale for photo-coagulation treatment of leaking aneurysmal or polypoidal components within the vascular lesion, but not the entire vascular complex. Photodynamic therapy seems to be a promising therapeutic modality, but randomized clinical trials are needed to establish the efficacy and safety of the PDT treatment in the management of these patients.