Korean J Ophthalmol.  2011 Apr;25(2):98-104. 10.3341/kjo.2011.25.2.98.

Time-Lag between Subretinal Fluid and Pigment Epithelial Detachment Reduction after Polypoidal Choroidal Vasculopathy Treatment

• Chae JB
• Lee JY
• Yang SJ
• Kim JG
• Yoon YH

• KMID: 1111870
• DOI: http://doi.org/10.3341/kjo.2011.25.2.98

Abstract

PURPOSE
The goal of the present research was to study post-treatment changes in polypoidal choroidal vasculopathy (PCV) shown by optical coherence tomography (OCT).
METHODS
The study included 12 patients with naive PCV. Photodynamic therapy and 3 consecutive intravitreal bevacizumab injections at 6-week intervals were given. Best corrected visual acuity, subretinal fluid (SRF), pigment epithelium detachment (PED), central macular thickness (CMT), and total macular volume (TMV) were measured before and after treatment as assessed by Stratus OCT3.
RESULTS
After treatment, the SRF height decreased earlier than the PED height. The SRF diameter decreased with statistical significance. However, the PED diameter did not show a statistically significant improvement, persisting at pre-treatment levels. Both CMT and TMV decreased significantly after treatment.
CONCLUSIONS
After PCV treatment, SRF and PED stabilized, as shown by OCT. However, the PED treatment response was both delayed and refractory compared to the SRF response. The small change in post-treatment PED diameter may suggest the possibility of PCV recurrence.

Keyword

Optical coherence tomography; Pigment epithelial detachment; Polypoidal choroidal vasculopathy

MeSH Terms

Aged
Choroid/*pathology
Choroid Diseases
Choroidal Neovascularization/diagnosis/*drug therapy
Disease Progression
Female
Fluorescein Angiography
Follow-Up Studies
Fundus Oculi
Humans
Male
Photochemotherapy/*adverse effects
Prognosis
Retinal Detachment/diagnosis/*etiology
Retinal Pigment Epithelium/*pathology
Retrospective Studies
*Subretinal Fluid
Time Factors
Tomography, Optical Coherence
Visual Acuity

Figure

• 

  Fig. 1 Heights and diameters of pigment epithelium detachment (PED) and subretinal fluid (SRF). The same scan direction was used at all follow-up visits to yield PED data (A) and SRF information (B).

• 

  Fig. 2 Polypoidal choroidal vasculopathy in the left eye of a woman 61 years of age. Fundus photography showed retinal hemorrhage (A). Indocyanine green angiography (ICG) revealed polyps and network vessels (B). An optical coherence tomography (OCT) transverse scan showed the polypoidal lesion (red arrow) and dome-shaped pigment epithelium detachment (PED) (yellow arrow) (C). After 6 months, the hemorrhage disappeared (D), and no active leakage was seen on fluorescein angiography (E). Follow-up ICG was not performed. OCT showed a decrease in PED height but a PED diameter persistently greater than normal (yellow arrow); subretinal fluid was absent (F). Twelve months later, there was no hemorrhagic lesion on fundus examination (G,H), however OCT showed persistence of the abnormally large PED diameter (I).

• 

  Fig. 3 Polypoidal choroidal vasculopathy in the right eye of a man 61 years of age. An orange-red subretinal hemorrhage with pigment epithelium detachment (PED) was observed on fundus photography (A). By indocyanine green angiography, a branching vascular network and polyps were observed (B). Optical coherence tomography showed 2 dome-shaped PED regions. The scanning direction was vertical (C). Three months after intravitreal bevacizumab and photodynamic therapy, the PED resolved (D). However, remnant PED areas were observed at the 9-month follow-up (red arrows) (E).

• 

  Fig. 4 Mean (± standard deviation) pigment epithelium detachment (PED) and subretinal fluid (SRF) heights of 12 polypoidal choroidal vasculopathy patients at baseline and all follow-ups. SRF height decreased at 1-,3-,6-,9- and 12-month follow-ups with clinical significance. PED heights showed no statistically significant decreases at the 1- and 3-month follow-ups. However, at the 6- and 9-month follow-ups, clinically significant decreases in the PED heights were observed.

• 

  Fig. 5 Pigment epithelium detachment (PED) and subretinal fluid (SRF) diameters at baseline and all follow-ups. The SRF diameter decreased with clinical and statistical significance at the 1-, 3-, and 9-month follow-ups (p-values 0.005, 0.013, and 0.043 respectively). However, there was no significant decrease in PED diameter at any follow-up.

• 

  Fig. 6 Central macular thickness (CMT) and total macular volume (TMV) of polypoidal choroidal vasculopathy patients at all follow-ups. Both CMT and TMV showed statistically significant decreases at all follow-up examinations.

• 

  Fig. 7 Best corrected visual acuity (BCVA) measurements at baseline and at all follow-ups. BCVA showed a tendency toward improvement, however this was neither clinically nor statistically significant. logMAR = logarithm of the minimum angle of resolution.

Reference

1. Spaide RF, Yannuzzi LA, Slakter JS, et al. Indocyanine green videoangiography of idiopathic polypoidal choroidal vasculopathy. Retina. 1995. 15:100–110.

2. Yannuzzi LA, Ciardella A, Spaide RF, et al. The expanding clinical spectrum of idiopathic polypoidal choroidal vasculopathy. Arch Ophthalmol. 1997. 115:478–485.

3. Yuzawa M, Mori R, Kawamura A. The origins of polypoidal choroidal vasculopathy. Br J Ophthalmol. 2005. 89:602–607.

4. Uyama M, Matsubara T, Fukushima I, et al. Idiopathic polypoidal choroidal vasculopathy in Japanese patients. Arch Ophthalmol. 1999. 117:1035–1042.

5. Uyama M, Wada M, Nagai Y, et al. Polypoidal choroidal vasculopathy: natural history. Am J Ophthalmol. 2002. 133:639–648.

6. Yannuzzi LA, Wong DW, Sforzolini BS, et al. Polypoidal choroidal vasculopathy and neovascularized age-related macular degeneration. Arch Ophthalmol. 1999. 117:1503–1510.

7. Moorthy RS, Lyon AT, Rabb MF, et al. Idiopathic polypoidal choroidal vasculopathy of the macula. Ophthalmology. 1998. 105:1380–1385.

8. Costa RA, Navajas EV, Farah ME, et al. Polypoidal choroidal vasculopathy: angiographic characterization of the network vascular elements and a new treatment paradigm. Prog Retin Eye Res. 2005. 24:560–586.

9. Ciardella AP, Donsoff IM, Huang SJ, et al. Polypoidal choroidal vasculopathy. Surv Ophthalmol. 2004. 49:25–37.

10. Tateiwa H, Kuroiwa S, Gaun S, et al. Polypoidal choroidal vasculopathy with large vascular network. Graefes Arch Clin Exp Ophthalmol. 2002. 240:354–361.

11. Yannuzzi LA, Flower RW, Slakter JS. Indocyanine green angiography. 1997. St. Louis: Mosby;329–339.

12. Kwok AK, Lai TY, Chan CW, et al. Polypoidal choroidal vasculopathy in Chinese patients. Br J Ophthalmol. 2002. 86:892–897.

13. Sho K, Takahashi K, Yamada H, et al. Polypoidal choroidal vasculopathy: incidence, demographic features, and clinical characteristics. Arch Ophthalmol. 2003. 121:1392–1396.

14. Yannuzzi LA, Nogueira FB, Spaide RF, et al. Idiopathic polypoidal choroidal vasculopathy: a peripheral lesion. Arch Ophthalmol. 1998. 116:382–383.

15. Gomez-Ulla F, Gonzalez F, Torreiro MG. Diode laser photocoagulation in idiopathic polypoidal choroidal vasculopathy. Retina. 1998. 18:481–483.

16. Yuzawa M, Mori R, Haruyama M. A study of laser photocoagulation for polypoidal choroidal vasculopathy. Jpn J Ophthalmol. 2003. 47:379–384.

17. Nishijima K, Takahashi M, Akita J, et al. Laser photocoagulation of indocyanine green angiographically identified feeder vessels to idiopathic polypoidal choroidal vasculopathy. Am J Ophthalmol. 2004. 137:770–773.

18. Akaza E, Mori R, Yuzawa M. Long-term results of photodynamic therapy of polypoidal choroidal vasculopathy. Retina. 2008. 28:717–722.

19. Lee SC, Seong YS, Kim SS, et al. Photodynamic therapy with verteporfin for polypoidal choroidal vasculopathy of the macula. Ophthalmologica. 2004. 218:193–201.

20. Gomi F, Ohji M, Sayanagi K, et al. One-year outcomes of photodynamic therapy in age-related macular degeneration and polypoidal choroidal vasculopathy in Japanese patients. Ophthalmology. 2008. 115:141–146.

21. Hussain N, Hussain A, Natarajan S. Role of photodynamic therapy in polypoidal choroidal vasculopathy. Indian J Ophthalmol. 2005. 53:101–104.

22. Spaide RF, Donsoff I, Lam DL, et al. Treatment of polypoidal choroidal vasculopathy with photodynamic therapy. Retina. 2002. 22:529–535.

23. Silva RM, Figueira J, Cachulo ML, et al. Polypoidal choroidal vasculopathy and photodynamic therapy with verteporfin. Graefes Arch Clin Exp Ophthalmol. 2005. 243:973–979.

24. Chan WM, Lam DS, Lai TY, et al. Photodynamic therapy with verteporfin for symptomatic polypoidal choroidal vasculopathy: one-year results of a prospective case series. Ophthalmology. 2004. 111:1576–1584.

25. Sato T, Kishi S, Watanabe G, et al. Tomographic features of branching vascular networks in polypoidal choroidal vasculopathy. Retina. 2007. 27:589–594.

26. Tsujikawa A, Sasahara M, Otani A, et al. Pigment epithelial detachment in polypoidal choroidal vasculopathy. Am J Ophthalmol. 2007. 143:102–111.

27. Lee WK, Lee PY, Lee SK. Photodynamic therapy for polypoidal choroidal vasculopathy: vaso-occlusive effect on the branching vascular network and origin of recurrence. Jpn J Ophthalmol. 2008. 52:108–115.

28. Yamashiro K, Tsujikawa A, Nishida A, et al. Recurrence of polypoidal choroidal vasculopathy after photodynamic therapy. Jpn J Ophthalmol. 2008. 52:457–462.