The Clinical Spectrum of Polypoidal Choroidal Vasculopathy in White Patients

Purpose

To describe clinical characteristics of polypoidal choroidal vasculopathy (PCV) in a large White cohort.

Design

Multicenter retrospective cohort study in 3 tertiary referral centers in the Netherlands.

Subjects

White patients with an indocyanine green angiography–confirmed diagnosis of PCV in 1 or both eyes.

Methods

The medical charts and multimodal imaging (MMI) of the included patients were assessed retrospectively by 2 independent assessors. Any discrepancies between graders were resolved by a senior retinal specialist. A predefined set of phenotypic characteristics was graded on MMI, including OCT, color fundus photography, fundus fluorescein angiography, and indocyanine green angiography.

Main Outcome Measures

Patients with polypoidal choroidal vasculopathy were distributed among 4 phenotypically different types, based on a previously published description: PCV with drusenoid age-related macular degeneration (AMD): PCV-AMD (type A); PCV without drusen but with a branching neovascular network (BNN): PCV-BNN (type B); isolated polypoidal choroidal vasculopathy (PCV-i) without drusen or a BNN: PCV-i (type C); and PCV with a background of central serous chorioretinopathy (CSC): PCV-CSC (type D).

Results

We included 332 eyes of 305 patients with PCV, with 179 of 305 patients being female (58.7%). The average age at diagnosis was 73 years. The included eyes had the following types: PCV-AMD in 188 eyes (58.4%); PCV-BNN in 61 eyes (18.9%); PCV-i in 15 eyes (4.7%); and PCV-CSC in 58 eyes (18.0%). Patients with PCV-AMD were older and more often female than patients with PCV-CSC. The median best-corrected visual acuity of affected eyes was 0.30 logarithm of the minimum angle of resolution (interquartile range, 0.10–0.52), with a large range in each type. A median of 2 polypoidal lesions per eye was found (range, 1–12), with no significant differences between types. The choroidal thickness beneath the fovea and beneath polypoidal lesions was significantly higher in PCV-CSC than in PCV-AMD (both P < 0.001).

Conclusions

Polypoidal choroidal vasculopathy in White patients comprises a spectrum of different phenotypes: it may present with signs of drusenoid AMD, with a background of CSC, or without signs of either diseases. We found a different phenotype distribution when compared with published findings in Asian patients with PCV.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any materials discussed in this article.