Combined cases of polypoidal choroidal vasculopathy and typical age-related macular degeneration

Department of Ophthalmology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1247, Japan.
Albrecht von Graæes Archiv für Ophthalmologie (Impact Factor: 1.91). 03/2010; 248(3):361-8. DOI: 10.1007/s00417-009-1276-2
Source: PubMed


When we classified neovascular exudative age-related macular degeneration (AMD) into three types of polypoidal choroidal vasculopathy (PCV), typical AMD, and retinal angiomatous proliferation (RAP) in our previous study, we reported 5.5% had the combined cases, such as one eye had PCV and the other eye had typical AMD. We examined the clinical characteristics of these combined cases in the current study.
All cases underwent fluorescein and indocyanine green angiography (FA and ICGA) at the initial examination. All PCV cases were diagnosed definitively based on characteristic aneurysmal lesions seen on ICGA. Follow-up examinations also were conducted to determine whether polypoidal lesions had developed in the eyes with typical AMD.
Among 349 patients with neovascular AMD, 20 (5.7%) had one eye with PCV and the other eye with typical AMD. The average age was 73 years. The mean best-corrected visual acuity levels at the initial examination in eyes with PCV and typical AMD were 0.20 and 0.43, respectively (p=0.09). All subgroups of classic and occult CNV were observed in the eyes with typical AMD on FA. During the follow-up period (average, 21.7 months), PCV developed in ten eyes with typical AMD at the initial examination.
Although some cases might include different stages of progression or probable cases of PCV, the combined cases in which one eye has PCV and the other eye has typical AMD suggest that those clinical entities are not independent and possibly overlap.

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    ABSTRACT: Polypoidal Choroidal Vasculopathy (PCV) is a condition characterized by chronic, multiple, recurrent serous and/or hemorrhagic detachments of the retinal pigment epithelium (RPE) and neurosensory retina. Although it has been described to more often affect Asians and individuals of pigmented races, PCV may also be present in white patients who present with the clinical appearance of age related macular degeneration (AMD). PCV and its treatment are discussed, including the use of combination therapy.
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    ABSTRACT: Purpose: To evaluate the angiographic features in using fundus camera-based versus confocal scanning laser ophthalmoscope (cSLO)-based indocyanine green angiography in differentiating polypoidal choroidal vasculopathy (PCV) from typical age-related macular degeneration. Methods: Sixty-five eyes of 44 patients with exudative maculopathy due to PCV or typical age-related macular degeneration were prospectively imaged with indocyanine green angiography using fundus camera and cSLO. Images were graded independently by retinal specialists. The main outcome measure was agreement between cSLO and fundus camera for the diagnosis of PCV. The rate of detection and area under the receiver operating characteristic curve of 7 preselected individual features were also compared. Results: The diagnosis of PCV was made with the cSLO system in 36 eyes (55.4%) and typical age-related macular degeneration in 29 eyes (44.6%), whereas the fundus camera diagnosed PCV in 39 eyes (60.0%) and typical age-related macular degeneration in 26 eyes (40.0%). There was moderate agreement between the two indocyanine green angiography systems (Kappa = 0.53). Using cSLO as the gold standard, fundus camera has a sensitivity and specificity of 83.3% and 69.0%, respectively. Typical nodular appearance was the most commonly detected feature (median, 88.9% for cSLO, 80.6% for fundus camera, P = 0.63) and had the highest area under the curve for the diagnosis of PCV in both systems (median, 80.2% for cSLO, 73.2% for fundus camera, P = 0.13). Confocal scanning laser ophthalmoscope was more sensitive in detecting branching vascular network and late hyperfluorescent plaque. Conclusion: Both systems detected >80% of PCV based on typical nodular appearance of polyps. However, the cSLO is superior in detecting additional features, particularly branching vascular network.
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