Toward a specific classification of polypoidal choroidal vasculopathy: idiopathic disease or subtype of age-related macular degeneration

Invest Ophthalmol Vis Sci. 2015 May;56(5):3187-95. doi: 10.1167/iovs.14-16236.

Abstract

Purpose: To suggest a clinical distinction between idiopathic polypoidal choroidal vasculopathy (PCV) and secondary polyps associated with neovascular age-related macular degeneration (NV-AMD).

Methods: The study was a retrospective case series of 52 eyes of 52 consecutive patients (31 females and 21 males) diagnosed with PCV. Initial diagnosis was based on scanning laser ophthalmoscope-indocyanine green angiography (SLO-ICGA) in association with fluorescein angiography (FA) and optical coherence tomography (OCT). All the data and images were analyzed in a masked fashion by four experienced examiners in two different sessions: the first, to classify patients into the two hypothesized groups (idiopathic polyps or NV-AMD-related polyps); the second, following a predetermined scheme, to describe objective features. The results obtained in each session underwent a cross multivariate analysis to identify statistically significant differences (P ≤ 0.05) between the two groups.

Results: The two groups were clinically different on the basis of FA (leakage origin [P = 0.001] and presence of drusen [P = 0.001]), ICGA (evidence of choroidal neovascularization [CNV; P = 0.001] and/or branching vascular network [BVN; P = 0.001]), OCT imaging (type of pigmented epithelium detachment [P = 0.001], presence of BVN [P = 0.001], and subfoveal choroidal thickness [P = 0.001]). Further significant differences were observed according to the location of lesion (uni- or multifocal) (P = 0.001), type of CNV (P = 0.001), and best-corrected visual acuity (P = 0.001).

Conclusions: Our study demonstrated clinical and statistically significant differences between idiopathic PCV and NV-AMD-related polyps that could be considered as distinct entities. Although they share some similarities, mainly the sub-RPE location, the ability to identify a specific clinical pattern suggests a more specific therapeutic approach for these two entities.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Choroid / pathology*
  • Choroidal Neovascularization / classification*
  • Choroidal Neovascularization / diagnosis
  • Coloring Agents
  • Diagnosis, Differential
  • Female
  • Fluorescein Angiography
  • Humans
  • Indocyanine Green
  • Male
  • Middle Aged
  • Multimodal Imaging
  • Ophthalmoscopy
  • Polyps / classification*
  • Polyps / diagnosis
  • Retrospective Studies
  • Tomography, Optical Coherence
  • Wet Macular Degeneration / classification*
  • Wet Macular Degeneration / diagnosis

Substances

  • Coloring Agents
  • Indocyanine Green