June 2015
Volume 56, Issue 6
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Research Highlight  |   June 2015
Two Subtypes of Polypoidal Choroidal Vasculopathy: Idiopathic Disease or Age-Related Macular Degeneration
Author Affiliations
  • Mitsuko Yuzawa
    Division of Ophthalmology Department of Visual Sciences, Nihon University School of Medicine, Tokyo, Japan; yuzawa.mitsuko@nihon-u.ac.jp
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 3998. doi:10.1167/iovs.15-17207
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      Mitsuko Yuzawa; Two Subtypes of Polypoidal Choroidal Vasculopathy: Idiopathic Disease or Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2015;56(6):3998. doi: 10.1167/iovs.15-17207.

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      © ARVO (1962-2015); The Authors (2016-present)

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Polypoidal choroidal vasculopathy (PCV) is characterized by a branching vascular network with polypoidal lesions at vessel termini under the retinal pigment epithelium (RPE). Although the classical presentation is recurrent serosanguineous RPE detachment, clinical features are indistinguishable from neovascular AMD. The initial description reported by Yannuzzi1 was that of a distinct clinical entity involving the choroidal vasculature. However, this entity now seems to be recognized as a specific form of neovascular AMD. 
Although a few studies have shown that PCV includes two different clinical entities (i.e., choroidal vasculature abnormalities and choroidal neovascularization (CNV) with polyps with AMD),2,3 the controversy remains regarding the definition of the disease itself. 
Coscas and colleagues4 classified PCV into two types, idiopathic PCV and neovascular AMD–related polyps. Their study clarified clinical differences in parameters of leakage on fluorescein angiograms, presence of drusen, branching vascular networks on indocyanine green angiograms, optical coherence tomography (OCT) imaging of subfoveal choroidal thickness, best-corrected visual acuity, and so on between these two subtypes of PCV. These differences seem to be sufficient for understanding the clinical distinctions between the two different forms of PCV. As visual prognosis and treatment strategies are thought to differ between CNV in AMD and choroidal vasculature abnormalities, more specific therapeutic approaches for these two entities merit further investigation, as suggested by the authors. 
References
Yannuzzi LA, Wong DW, Sforzolini BS, et al. Polypoidal choroidal vasculopathy and neovascularized age-related macular degeneration. Arch Ophthalmol. 1999; 117: 1503–1510.
Kawamura A, Yuzawa M, Mori R, et al. Indocyanine green angiographic and optical coherence tomographic findings support classification of polypoidal choroidal vasculopathy into two types. Acta Ophthalmol. 2013; 91: e474–e481.
Tanaka K, Nakayama T, Mori R, et al. Associations of complement factor H (CFH) and age-related maculopathy susceptibility 2 (ARMS2) genotypes with subtypes of polypoidal choroidal vasculopathy. Invest Ophthalmol Vis Sci. 2011; 52: 7441–7444.
Coscas G, Lupidi M, Coscas F, et al. Toward a specific classification of polypoidal choroidal vasculopathy: idiopathic disease or subtype of age-related macular degeneration. Invest Ophthalmol Vis Sci. 2015; 56: 3187–3195.
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