Korean J Ophthalmol.  2019 Feb;33(1):54-62. 10.3341/kjo.2018.0048.

Novel Findings of Polypoidal Choroidal Vasculopathy via Optical Coherence Tomography Angiography

• Seong S
• Choo HG
• Kim YJ
• Kim JY
• Lee JH
• Oh HS
• You YS
• Kim SH
• Kwon OW

• KMID: 2434305
• DOI: http://doi.org/10.3341/kjo.2018.0048

Abstract

PURPOSE
To introduce novel findings of polypoidal choroidal vasculopathy (PCV) via optical coherence tomography angiography (OCTA)
METHODS
This study is a retrospective chart review of 16 patients (16 eyes) with PCV. OCTA (Avanti RTVue XR) findings were evaluated and selected for analysis after agreement by two retina specialists .
RESULTS
Twenty one polyps in 16 eyes (16 patients) with PCV were included in this study. The mean patient age was 67 years (13 men and three women). The shape of polypoidal lesions on OCTA at initial were halo (five polyps), rosette (seven polyps), and vascular network (nine polyps). Eight months after anti-vascular endothelial growth factor treatment, in a total of four eyes, seven polyps could be followed up completely, the two halo type polypoidal lesions changed to rosette and vascular network type. The lesions of three rosette and two vascular network type lesions did not change in shape. In addition, the size of the polypoidal lesions (one among two halo types, two among three rosette types, and two among two vascular network types) decreased, but one halo type did not change and one rosette type increased in size on OCTA.
CONCLUSIONS
En-face OCTA enabled us to categorize novel types of PCV with polypoidal lesions.

Keyword

Indocyanine green angiography; Optical coherence tomography; Optical coherence tomography angiography; Polypoidal choroidal vasculopathy

MeSH Terms

Angiography*
Choroid*
Endothelial Growth Factors
Humans
Male
Polyps
Retina
Retrospective Studies
Specialization
Tomography, Optical Coherence*
Endothelial Growth Factors

Figure

• 

  Fig. 1 Case 1 indocyanine green angiography (ICGA), optical coherence tomography angiography (OCTA), En Face, and spectral-domain optical coherence tomography (SD-OCT) findings. (A) Two hot spots (cluster and aneurysm, white arrow and arrowhead) of polypoidal lesions and branching vascular network (BVN, black arrow) were detected on ICGA. (B) Two round and high-flow outlined with dark halo polypoidal lesions (arrow and arrowhead, yellow colored area) were detected on OCTA. (C) These polpypoidal lesions were also detected on En-Face image (cluster and aneurysm, white arrow and arrowhead). (D) BVN (arrow) was identified on OCTA. (E) Cluster type of polypoidal lesion was disappeared after treatment, but aneurysm type was still remained on ICGA (cluster and aneurysm, white arrow and arrowhead; BVN, black arrow). (F) Large-sized halo type of polyp (arrow) was changed to vascular network type, and small-sized halo type polyp (arrowhead) was changed into rosette type on OCTA. (G) En-Face finding of polyps after treatment (cluster and aneurysm, white arrow and arrowhead). (H) Decreased the area of BVN (arrow) on OCTA. (I,J) SD-OCT finding of polyps (arrow) at initial and after treatment. (K,L) 3D finding of polyp at initial and after treatment.

• 

  Fig. 2 Case 2 indocyanine green angiography (ICGA), optical coherence tomography angiography (OCTA), En Face, and spectral-domain optical coherence tomography (SD-OCT) findings. (A) Cluster type of polypoidal lesion (white arrow) and branching vascular network (BVN, black arrow) were detected on ICGA. (B) High-flow vascular network polypoidal lesions (white arrow and yellow colored area) was detected on OCTA. (C) This polpypoidal lesion (white arrow) was also detected on En-Face image. (D) BVN (arrow) was identified on OCTA. (E) Decreased size of cluster type polypoidal lesion (white arrow) and BVN (black arrow) after treatment on ICGA. (F) Vascular network type of polyp (white arrow) was maintained as the original type on OCTA. (G) En-Face finding of polyp (white arrow) after treatment. (H) Decreased the area of BVN (arrow) on OCTA. (I,J) SD-OCT finding of polyps (arrow) at initial and after treatment. (K,L) 3D finding of polyp at initial and after treatment.

• 

  Fig. 3 Case 3 indocyanine green angiography (ICGA), optical coherence tomography angiography (OCTA), En Face, and spectral-domain optical coherence tomography (SD-OCT) findings. (A) Two hot spots (aneurysms, white arrow and arrowhead) of polypoidal lesions and branching vascular network (BVN, black arrow) were detected on ICGA. (B) High-flow outlined with irregular dark halo, the rosette type, polypoidal lesions (arrow) and high-flow vascular network type polypoidal lesion (arrowhead, in the small box) were detected on OCTA (yellow colored area). (C) These polpypoidal lesions (white arrow and arrow head) were also detected on En-Face image. (D) BVN (arrow) was identified on OCTA. (E) The brighter and large-sized aneurysm type of polypoidal lesion (white arrow) was increased the size, but the relatively faint aneurysm type (arrowhead) was almost disappeared after treatment on ICGA (BVN, black arrow). (F) The rosette type (arrow) and the vascular network type (arrowhead, in the small box) were unchanged as the original types after treatment on OCTA. (G) En-Face finding of polyps (white arrow and arrow head) after treatment. (H) Increased the area of BVN (arrow) on OCTA after treatment. (I,J) SD-OCT finding of polyps (arrow) at initial and after treatment. (K,L) 3D finding of polyps at initial and after treatment.

• 

  Fig. 4 Case 4 indocyanine green angiography (ICGA), optical coherence tomography angiography (OCTA), En Face, and spectral-domain optical coherence tomography (SD-OCT) findings. (A) One hot spots (aneurysm, white arrow) of polypoidal lesion and branching vascular network (BVN, black arrow) were detected on ICGA. (B) Two round and high-flow outlined with irregular dark halo polypoidal lesions (arrow and arrowhead) were detected on OCTA. (C) These polpypoidal lesions (white arrow and arrowhead) were also detected on En-Face image. (D) BVN (arrow) was identified on OCTA. (E) The fluorescence of aneurysm type of polypoidal lesion (white arrow) was decreased size after treatment (BVN, black arrow). (F) Two rosette type polyps (arrow and arrowhead) were remained as the original types after treatment on OCTA. (G) En-Face finding of polyps (white arrow and arrowhead) after treatment. (H) Decreased the area of BVN (arrow) on OCTA after treatment. (I,J) SD-OCT finding of polyps (white arrow and arrowhead) at initial and after treatment. (K,L) 3D finding of polyps at initial and after treatment.

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