Clinical and Multimodal Imaging of Idiopathic Polypoidal Choroidal Vasculopathy in Tertiary Eye Hospital

Abstract

Background: Idiopathic Polypoidal Choroidal Vasculopathy (IPCV) is a distinct variant of neovascular age-related macular degeneration (nAMD) prevalent in Asian populations.

Objective: To describe the demographic, clinical, and multimodal imaging characteristics of patients with treatment-naïve PCV.

Methods:This observational study which included 25 eyes of 25 patients of IPCV of patients diagnosed with PCV at tertiary eye hospital between from June 2022 to May 2023. The study was approved by the Institutional Review Committee ( Ref.:2905202207). Data were collected included age, sex, best corrected visual acuity (BCVA), fundus photography and spectral-domain optical coherence tomography (SD-OCT) and OCT angiography feature such as choroidal thickness, polyp location, presence of subretinal fluid (SRF), and specific signs like sharp-peaked pigment epithelial detachments (PEDs) and the double-layer sign. Branching vascular network (BVN) type was classified based on OCT angiography.

Results: The mean age of patients was 65.4 ± 8.9 years, with a female predominance (56.0%). The mean logMAR BCVA was 0.66 ± 0.24. The mean subfoveal choroidal thickness was 372.5 ± 45.3 µm. A sharp-peaked PED, internal reflectivity, and the double-layer sign were present in all eyes (100%). Subretinal fluid was present in 84% of eyes. Type II (glomerular) BVN was the most common (44.0%), and juxtafoveal was the most common polyp location (48.0%). A significant positive correlation was found between age and choroidal thickness (r = 0.43, p = 0.037). Choroidal thickness was significant with Type III (stick) BVN type (p=0.03). Eyes with subfoveal polyps had significantly worse VA than those with non-subfoveal polyps (0.80 vs. 0.61 logMAR,p=0.04).

Conclusion: A positive correlation between age and choroidal thickness contrasts with the usual age-related thinning and defines the pachychoroid nature of PCV. The association between poorer vision and subfoveal polyp location, along with differences in choroidal thickness by BVN type, reflects the disease’s clinical variability.