Polypoidal choroidal vasculopathy with an exceptionally elevated pigment epithelial detachment.

Area of Science:

• Ophthalmology
• Medical Imaging
• Retinal Diseases

Background:

• Presents a unique case of polypoidal choroidal vasculopathy (PCV).
• Highlights an exceptionally elevated pigment epithelial detachment (PED) as a key feature.
• Focuses on the diagnostic challenges and treatment considerations for atypical PCV presentations.

Observation:

• A 48-year-old woman presented with a large, elevated lesion in the macula.
• Fundus examination and Indocyanine Green Angiography (ICGA) showed characteristics of PCV with extensive vascularization.
• Optical coherence tomography revealed an extremely elevated PED (>2500 μm) with associated subretinal and intraretinal fluid.

Findings:

• Multimodal imaging confirmed an atypical PCV with extensive polypoidal lesions and choroidal neovascularization.
• The significantly elevated PED posed a high risk of retinal pigment epithelium tear.
• Photodynamic therapy was chosen over anti-VEGF due to the high-risk PED.

Implications:

• Photodynamic therapy demonstrated efficacy in achieving complete regression of the PCV lesion.
• This case underscores the importance of tailored treatment strategies for complex PCV cases.
• Successful treatment resulted in the preservation of excellent visual acuity, demonstrating a favorable outcome.