Korean J Ophthalmol.  2005 Dec;19(4):275-280. 10.3341/kjo.2005.19.4.275.

Optical Coherence Tomography of Idiopathic Polypoidal Choroidal Vasculopathy

• Sa HS
• Cho HY
• Kang SW

• KMID: 754439
• DOI: http://doi.org/10.3341/kjo.2005.19.4.275

Abstract

PURPOSE
To characterize cross-sectional images of idiopathic polypoidal choroidal vasculopathy (PCV). METHODS: A cross-sectional and retrospective study was performed involving 28 eyes with PCV and 112 eyes with exudative age-related macular degeneration. The frequency and dimensions of the retinal pigment epithelial detachment (RPED) with attenuation of internal reflectivity on optical coherence tomographic (OCT) examination were compared in both diseases. RESULTS: OCT showed the RPED with attenuation of internal reflectivity corresponding to the polypoidal structure in the indocyanine green angiogram in 75% of eyes with PCV, which was significantly more frequent than in eyes with exudative age-related macular degeneration (3.6%). In lesions suspicious of exudative age-related macular degeneration or PCV, the RPED with attenuation of internal reflectivity on OCT images strongly supported PCV diagnosis with a sensitivity of 84% and a specificity of 94%. The base diameter (p=0.010) and base diameter times height (p=0.028) of RPED were smaller in PCV than in exudative age-related macular degeneration. CONCLUSIONS: An RPED with attenuation of internal reflectivity in OCT examination is a highly sensitive and specific finding which characterizes PCV. Recognition of this RPED appearance, as well as the evaluation of its size, aids in the diagnosis of PCV.

Keyword

Optical coherence tomogram; Polypoidal choroidal vasculopathy

MeSH Terms

*Tomography, Optical Coherence
Sensitivity and Specificity
Retrospective Studies
Middle Aged
Male
Macular Degeneration/diagnosis
Humans
Fundus Oculi
Fluorescein Angiography
Female
Diagnosis, Differential
Cross-Sectional Studies
Choroid Diseases/*pathology
Choroid/*blood supply
Aged, 80 and over
Aged

Figure

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  Fig. 1 (A) Fundus photogram of the right eye shows pigment epithelial detachment, subretinal hemorrhages and orange-red nodular elevations of the retinal pigment epithelium (arrows). The optical coherence tomographic (OCT) scan line is indicated by a whitish horizontal line. Indocyanine green angiogram reveals polypoidal vascular dilatations (arrows) at the termini of a branching network of inner choroidal vessels (arrowhead) and confirms the diagnosis of polypoidal choroidal vasculopathy. OCT shows a dome-like elevation of a highly reflective band corresponding to the detached retinal pigment epithelium. There are moderate focal reflections just beneath the elevation and attenuation of optical reflectivity under these reflections. (B) OCT image of serous retinal pigment epithelial detachment in age-related macular degeneration demonstrates an elevation of the retinal pigment epithelium over an optically clear space corresponding to a serous fluid collection without shadowing of the choroids. (C) OCT image of hemorrhagic retinal pigment epithelial detachment developed in a case of exudative age-related macular degeneration shows a dense reflective band beneath the pigment epithelium and complete optical shadowing under the reflective band.

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  Fig. 2 A representative OCT image of RPED with attenuation of internal reflectivity. The red area indicates the retinal pigment epithelium. The vertical arrow indicates the height and the horizontal arrow indicates the base diameter.

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  Fig. 3 Scattergram demonstrating the relationship between the base diameter and height of the retinal pigment epithelial detachments with optical shadowing in eyes with PCV (triangle) and exudative age-related macular degeneration (dot). The RPEDs with optical shadowing in eyes with PCV tend to be smaller than those of exudative age-related macular degeneration.

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