Exploring clinical features of polypoidal choroidal vasculopathy in black patients: a cross-sectional study and a comprehensive review.

Abstract

Objective: This study aimed to evaluate the clinical and angiographic presentation of polypoidal choroidal vasculopathy (PCV) in a large cohort of Black patients.

Design: We conducted a descriptive cross-sectional analysis.

Participants: Out of 283 patients followed for PCV in our department, 167 cases were confirmed by ICG. The remaining patients lacked ICG imaging. Among the 167 confirmed cases, 57 patients were excluded due to significant ophthalmological comorbidities, leaving 160 affected eyes in 110 patients for analysis.

Methods: We reviewed the most recent retinophotography, optical coherence tomography (OCT), fluorescein, and indocyanine green angiography (ICGA) images in our database. All analyzed patients were followed and underwent their examinations at the University Hospital Center of Martinique, a referral center in Fort-de-France primarily serving a Black population. An exploratory analysis of choroidal features was made in those who underwent enhanced depth imaging spectral-domain OCT (EDI-SD-OCT). In parallel, a literature review on PCV was performed to contextualize our findings.

Main outcomes and measures: We measured visual acuity, sex ratio, patient age, characteristics of exudative phenomena, polyp location, and PCV type according to Kawamura classification.

Results: Most patients were women (62.7%), with an average age of 72.2 ± 10.1 years. Among the 160 eyes, 81.9% exhibited idiopathic Type 2 PCV and 52.4% showing peripapillary polyp distribution. The mean visual acuity was 0.29 ± 0.3 LogMAR. Soft drusen were present in 15% of eyes and 44.5% of patients had bilateral involvement. Black patients seem to have distinctive PCV characteristics compared to other ethnic groups, with a low incidence of macular polyps (23.1%), a high incidence of peripapillary polyps (52.4%) and high incidence of bilateral involvement (42.8%).

Conclusions and relevance: This is the largest series of Afro-descendant patients with polypoidal choroidal vasculopathy (PCV) ever described in the literature. PCV in our population is primarily type 2 PCV according to Kawamura's classification, predominantly affecting women, often bilateral, with a preferentially extramacular location of the polyps. These observations may be explained by the fact that PCV in these patients is not the result of neovascularization but rather linked to a generalized disease of the choroid, such as pachychoroid.