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Published on: May 26, 2023
Differentiating Exudative Macular Degeneration and Polypoidal Choroidal Vasculopathy Using OCT B-Scan
Gregg T Kokame1, Jase N Omizo2, Kelli A Kokame3
1Division of Ophthalmology, Department of Surgery, University of Hawaii School of Medicine, Honolulu, Hawaii; University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii; Hawaii Macula and Retina Institute, Aiea, Hawaii; Retina Consultants of Hawaii, Aiea, Hawaii; The Retina Center at Pali Momi, Aiea, Hawaii.
Polypoidal choroidal vasculopathy (PCV) can be identified on OCT B-scans by inverted U-shaped lesions, especially before treatment. These characteristic findings aid in diagnosing PCV when indocyanine green angiography is unavailable.
Area of Science:
- Ophthalmology
- Medical Imaging
- Retinal Diseases
Background:
- Polypoidal choroidal vasculopathy (PCV) diagnosis often relies on indocyanine green angiography (ICGA), which is not always accessible.
- Optical coherence tomography (OCT) B-scans offer a widely available alternative for visualizing PCV-specific lesions.
- PCV presents distinct features on OCT B-scans, such as inverted U-shaped elevations of the retinal pigment epithelium (RPE).
Purpose of the Study:
- To differentiate between PCV and typical exudative age-related macular degeneration (AMD) using ICGA findings.
- To compare OCT B-scan findings between eyes diagnosed with PCV and typical exudative AMD.
- To assess the diagnostic utility of OCT B-scans in identifying PCV, particularly when ICGA is unavailable.
Main Methods:
- A retrospective chart review compared clinical features of eyes with PCV and typical exudative AMD, confirmed by ICGA.
- OCT B-scans were analyzed for specific features including inverted U-shaped polypoidal lesions, subretinal fluid (SRF), macular edema, subretinal hyperreflective material (SHRM), and retinal pigment epithelial detachment (RPED).
- Findings were evaluated at baseline and after 6-9 months of antiangiogenic therapy, with a focus on the presence of polypoidal lesions before and after treatment.
Main Results:
- Of 112 eyes, 69 had PCV and 43 had typical exudative AMD.
- PCV eyes showed a higher prevalence of SRF at baseline and post-treatment compared to AMD eyes.
- Visible polypoidal lesions on OCT B-scans decreased from 56.5% to 24.6% after treatment in PCV eyes.
Conclusions:
- OCT B-scans can reveal characteristic inverted U-shaped polypoidal lesions in PCV, especially at baseline before anti-VEGF therapy.
- The presence of these lesions on baseline OCT B-scans is crucial for diagnosing PCV when ICGA is not performed.
- Subretinal fluid is more common in PCV than in non-PCV AMD, further supporting OCT B-scan utility in differentiation.
