Polypoidal choroidal vasculopathy associated with tilted disk syndrome

Area of Science:

• Ophthalmology
• Retinal Vascular Diseases
• Choroidal Neovascularization

Background:

• Tilted disk syndrome is a congenital optic disc anomaly.
• Macular serous retinal detachment is a potential complication affecting central vision.
• Polypoidal choroidal vasculopathy (PCV) involves abnormal blood vessels under the retina.

Purpose of the Study:

• To report a case of macular serous retinal detachment secondary to PCV in a patient with tilted disk syndrome.
• To describe the diagnostic utility of indocyanine green angiography (ICG) and optical coherence tomography (OCT).
• To evaluate the efficacy of photodynamic therapy (PDT) in managing this specific complication.

Main Methods:

• A 65-year-old patient presenting with visual loss and metamorphopsia underwent comprehensive ophthalmic evaluation.
• Diagnostic imaging included fluorescein angiography, ICG angiography, and OCT.
• Treatment involved photodynamic therapy (PDT) using verteporfin.

Main Results:

• Fundus examination revealed tilted disk syndrome and a unilateral macular serous detachment.
• ICG angiography clearly delineated a polypoidal lesion at a macular lacquer crack, confirming PCV.
• The lesion resolved post-PDT, with sustained visual acuity of 20/25 and no distortion at 2-year follow-up.

Conclusions:

• Polypoidal choroidal vasculopathy can be a complication of tilted disk syndrome, leading to macular serous detachment.
• ICG angiography is crucial for diagnosing PCV in this context.
• PDT offers a successful treatment option for PCV-associated macular serous detachment in tilted disk syndrome.