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Colin S Tan, Wei Kiong Ngo, Louis W Lim, Tock Han Lim; Optical coherence tomography features of Polypoidal Choroidal Vasculopathy and their impact on visual outcomes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4044.
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To describe the features of Polypoidal Choroidal Vasculopathy (PCV) seen on optical coherence tomography (OCT) and its impact on the long-term visual prognosis.
Fifty-three consecutive patients with PCV presenting to a retina subspecialty clinic were imaged using confocal scanning laser ophthalmoscopy fluorescein angiography (FA) and indocyanine green angiography (ICGA). PCV was diagnosed using standardised ICGA diagnostic criteria. Quantitative and qualitative OCT features were graded independently by two ophthalmologists, and this was correlated with visual acuity (VA) over a 5-year period.
PCV lesions were characterized by the presence of increased reflectivity beneath a steep elevation of the retinal pigment epithelium (RPE). Pigment epithelium detachments which were part of the PCV lesions had a “double-hump” in 70% of cases. Of the 53 patients, 23 (43.4%) had no significant leakage on FA (Group 1) while the remaining 30 (56.6%) exhibited significant FA leakage (Group 2). Patients in Group 1 had significantly less subretinal fluid (88.3 µm vs. 135.3 µm, p<0.001) and retinal thickening (322.6 µm vs. 443.7 µm, p<0.001) compared to Group 2. Patients in Group 2 also had higher rates of intraretinal cysts. Those in Group 1 had significantly better LogMAR VA at all time points compared to Group 2 (0.32 vs. 1.04 at 5 years, p<0.001), and experienced lower rates of moderate visual loss (7.4% vs. 40.6%, p=0.003).
In patients with PCV, the presence of significant FA leakage on presentation is associated with higher rates of visual loss and poor visual outcomes over 5 years. The angiographic characteristics of PCV may be an important prognostic indicator and can guide management of patients.
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