Idiopathic polypoidal choroidal vasculopathy of the macula☆
Presented in part as a poster at the Association for Research in Vision and Ophthalmology, Fort Lauderdale, Florida, April 1996, and the Annual Meeting of the American Academy of Ophthalmology, Chicago, Illinois, October 1996.
Received 23 April 1997; accepted 12 January 1998.
Abstract
Objective
The authors evaluated the clinical, fluorescein, and indocyanine green (ICG) angiographic characteristics of the macular variant of idiopathic polypoidal choroidal vasculopathy (IPCV).
Design
Observational case series.
Participants
The records, photographs, and fluorescein and ICG angiograms of eight eyes of seven patients with IPCV lesions confined to the macula were reviewed.
Main outcome measures
The visual acuity, fundus examination, fluorescein and ICG angiographic characteristics, and clinical course were compared.
Results
All patients demonstrated polypoidal lesions arising from macular choroidal vessels on ICG angiography. One patient had bilateral lesions. These lesions appeared hyperfluorescent in the early phases of both fluorescein and ICG angiography. Late-phase leakage was seen in cases associated with subretinal fluid or exudate. None of these patients demonstrated polypoidal lesions arising from the peripapillary choroidal circulation or peripapillary choroidal neovascularization. Three eyes with polypoidal lesions that were associated with subretinal fluid and exudates were treated with photocoagulation. Five eyes were not treated. Final visual acuity ranged from 20/20 to hand motions. Severe visual loss was associated with vitreous and subretinal hemorrhage, but this resolved without permanent severe visual loss in several cases.
Conclusions
In the macular variant of IPCV, ICG and fluorescein angiography demonstrate characteristic macular polypoidal lesions without evidence of peripapillary lesions. The vascular origin of these polypoidal lesions appears to be the macular choroidal circulation. This is distinguished from classic IPCV, in which lesions appear to arise from the peripapillary choroidal circulation. Visual prognosis appears to be good, with most patients retaining visual acuity of 20/80 or better. If subretinal fluid or exudates reduce visual acuity, photocoagulation should be considered.
Manuscript no. 97221
1Associated Vitreoretinal and Uveitis Consultants, Indianapolis, Indiana, USA
2Northwestern University Medical School, Chicago, Illinois, USA
3The University of Illinois at Chicago, Chicago, Illinois, USA
4Vitreous-Retina-Macula Consultants of New York, PC, New York, New York, USA
Reprint requests to Alice T. Lyon, MD, Department of Ophthalmology, Northwestern University Medical School, Suite 440, 645 N. Michigan Ave, Chicago, IL 60611 USA
☆ Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York (ATL, LMJ), The Illinois Retina Fund, Chicago, Illinois (MFR), and The Macula Foundation of the LuEsther T. Mertz Retinal Research Laboratory, New York, New York (RFS, LAY).
ABSTRACT