The Clinical Spectrum of Polypoidal Choroidal Vasculopathy in White Patients: A Retrospective Multicenter Cohort
Marc J Sirks1, Elon H C van Dijk2, Husein Ghalayini3
1Department of Ophthalmology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Retina, Rotterdam Eye Hospital, Rotterdam, the Netherlands.
Insights
Polypoidal choroidal vasculopathy (PCV) in Caucasians presents diverse phenotypes, differing from Asian populations. This study characterizes these clinical features in a large Caucasian cohort.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Vascular Anomalies
Background:
- Polypoidal choroidal vasculopathy (PCV) is a subtype of age-related macular degeneration (AMD).
- Understanding PCV phenotypes is crucial for diagnosis and treatment.
- Previous studies primarily focused on Asian populations, with limited data on Caucasian cohorts.
Purpose of the Study:
- To delineate the clinical characteristics of polypoidal choroidal vasculopathy (PCV) within a substantial Caucasian patient group.
- To categorize PCV phenotypes based on multimodal imaging and clinical presentation.
Main Methods:
- A multicenter retrospective cohort study was conducted across three tertiary referral centers in the Netherlands.
- Data from 305 Caucasian PCV patients (332 eyes) with confirmed diagnoses via indocyanine green angiography were analyzed.
- Multimodal imaging, including optical coherence tomography and angiography, was used to assess phenotypic characteristics.
Main Results:
- The study identified four PCV phenotypes: PCV-AMD (58.4%), PCV-BNN (18.9%), PCV-i (4.7%), and PCV-CSC (18.0%).
- Patients with PCV-AMD were older and more frequently female compared to those with PCV-CSC.
- Choroidal thickness was significantly greater in PCV-CSC than in PCV-AMD.
Conclusions:
- Caucasian PCV exhibits a spectrum of phenotypes, including presentations with drusenoid AMD, central serous chorioretinopathy (CSC), or neither.
- The observed phenotype distribution in Caucasians differs from that reported in Asian populations.
- These findings highlight the phenotypic heterogeneity of PCV across different ethnicities.
Purpose:
To describe clinical characteristics of polypoidal choroidal vasculopathy (PCV) in a large White cohort.
Design:
Multicenter retrospective cohort study in 3 tertiary referral centers in the Netherlands.
Subjects:
White patients with an indocyanine green angiography-confirmed diagnosis of PCV in 1 or both eyes.
Methods:
The medical charts and multimodal imaging (MMI) of the included patients were assessed retrospectively by 2 independent assessors. Any discrepancies between graders were resolved by a senior retinal specialist. A predefined set of phenotypic characteristics was graded on MMI, including OCT, color fundus photography, fundus fluorescein angiography, and indocyanine green angiography.
Main Outcome Measures:
Patients with polypoidal choroidal vasculopathy were distributed among 4 phenotypically different types, based on a previously published description: PCV with drusenoid age-related macular degeneration (AMD): PCV-AMD (type A); PCV without drusen but with a branching neovascular network (BNN): PCV-BNN (type B); isolated polypoidal choroidal vasculopathy (PCV-i) without drusen or a BNN: PCV-i (type C); and PCV with a background of central serous chorioretinopathy (CSC): PCV-CSC (type D).
Results:
We included 332 eyes of 305 patients with PCV, with 179 of 305 patients being female (58.7%). The average age at diagnosis was 73 years. The included eyes had the following types: PCV-AMD in 188 eyes (58.4%); PCV-BNN in 61 eyes (18.9%); PCV-i in 15 eyes (4.7%); and PCV-CSC in 58 eyes (18.0%). Patients with PCV-AMD were older and more often female than patients with PCV-CSC. The median best-corrected visual acuity of affected eyes was 0.30 logarithm of the minimum angle of resolution (interquartile range, 0.10-0.52), with a large range in each type. A median of 2 polypoidal lesions per eye was found (range, 1-12), with no significant differences between types. The choroidal thickness beneath the fovea and beneath polypoidal lesions was significantly higher in PCV-CSC than in PCV-AMD (both P < 0.001).
Conclusions:
Polypoidal choroidal vasculopathy in White patients comprises a spectrum of different phenotypes: it may present with signs of drusenoid AMD, with a background of CSC, or without signs of either diseases. We found a different phenotype distribution when compared with published findings in Asian patients with PCV.
Financial Disclosure(S):
The authors have no proprietary or commercial interest in any materials discussed in this article.
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