Polypoidal choroidal vasculopathy and late geographic hyperfluorescence on indocyanine green angiography

To report the clinical significance of late geographic hyperfluorescence (LGH) on indocyanine green angiography (ICGA) in cases of polypoidal choroidal vasculopathy (PCV).

The medical records of 43 eyes with PCV, all of which had undergone at least 12 months of follow-up, 40 eyes with exudative age-related macular degeneration (AMD) and 20 eyes of age-matched normal subjects were retrospectively analysed. The incidence of LGH, defined as a well-demarcated geographic hyperfluorescent lesion on late phase ICGA, was compared in each respective group. The natural course of the LGH and its changes after photodynamic therapy (PDT) were analysed.

LGH was noted in all of the eyes with PCV, whereas LGH was noted in three eyes (7.5%) of the eyes with exudative AMD and was not noted in any of the normal subjects (p<0.01). Of the 27 eyes (62.8%) with PCV, LGH was matched to the total area of the branching vascular network and polyps. The extent of LGH was enlarged over time in approximately one-half of the cases. As compared with the eyes demonstrating persistent LGH after PDT, the eyes with fading or disappearing LGH evidenced a lower recurrence of active PCV (p<0.05).

LGH is a highly sensitive and specific ICGA finding for the diagnosis of PCV. Increased surveillance should be implemented in eyes in which LGH persists after PDT.