Clinical features and classification framework of polypoidal choroidal vasculopathy in Saudi populations.

Introduction: The Changes in visual acuity(VA) can be caused by polypoidal choroidal vasculopathy(PCV), a subtype of macular neovascularization which is characterized by the formation of polyp-like structures under the retinal pigment epithelium. PCV has been commonly found concurrent with the neovascular age-related macular degeneration (nAMD), which has led to the debate regarding whether, it should be viewed as an independent entity or as a subset of nAMD. The insight into the clinical features of PCV and its therapeutic response such as understanding the prognosis of this disease is very crucial for management and better outcomes. This study aims to differentiate the different types of PCV, and assess its clinical features, disease progression, and treatment options available for Saudi patients and also examine the effectiveness of different treatment modalities.

Materials and methods: A retrospective study was conducted in Saudi Arabia among 39 PCV diagnosed patients, using multimodal imaging technique for assessment such as fundus imaging, OCT and ICGA. Patients were classified into three subtypes: age-related macular degeneration-associated PCV(PCV-AMD, Type A), a group with posterior-capsule-vitreous neovascularization-associated PCV (PCV-BVN, Type B), and idiopathic PCV (Type C). The treatment options available were photodynamic therapy(PDT), thermal laser therapy and anti-vascular endothelial growth factor (anti-VEGF) therapy. The clinical and visual outcomes were evaluated at the end of 1 year. SPSS version 23 was used to conduct statistical analysis, including chi-square, ANOVA and Kruskal-Wallis tests (p < 0.05).

Results: PCV-AMD was the most common subtype(75.7%), followed by PCV-BVN (13.5%) and idiopathic PCV (10.8%). The median age was 68 years, with idiopathic PCV patients being significantly younger (p = 0.012). Most lesions were macular (94.6%) with peaked/dome-shaped RPE elevations (94.6%). Anti-VEGF therapy was administered in 94.6% of cases, with aflibercept usage differing significantly across subtypes (p = 0.018). Complete lesion resolution was achieved in 45.9%, with PCV-BVN showing the highest resolution rate (80%) and idiopathic PCV the lowest at(0%).

Conclusion: PCV is predominantly presents as a variant of nAMD, with significant differences in subtype characteristics and treatment response. While anti-VEGF therapy remains the mainstay of treatment, idiopathic PCV appears more refractory, necessitating the individualized therapeutic strategies. Additional future studies are required to enhance management strategies for this condition.