Abstract
Purpose: :
Polypoidal choroidal vasculopathy (PCV) occurs more commonly in Asian populations, and its reported visual outcome in the literature is variable. However, there is limited information regarding its long-term clinical course and prognosis. We aimed to describe the epidemiology, natural history and factors affecting treatment outcomes of PCV in a multi-ethnic Asian population.
Methods: :
A 5-year longitudinal study of 112 eyes of 102 consecutive patients with PCV seen at Tan Tock Seng Hospital, Singapore. PCV was diagnosed by trained ophthalmologists using standardized diagnostic criteria. Risk factors for visual loss were analyzed using multivariate logistic regression.
Results: :
The mean age of the 102 patients was 66.4 ± 9.8 years, with 64 males (62.7%) and 38 females. Of these, 88 (87.5%) were Chinese, 10 (8.9%) were Malay and 4 (3.6%) were Indian. Subretinal hemorrhage occurred in 47.5% of eyes, with massive hemorrhage occurring in 17.1%. PCV lesions occurred predominantly at the macula (86.0%), while 7.5% were extramacular (7.5%) and 6.5% peripapillary. Good visual outcomes (visual acuity [VA] ≥20/40) were achieved in 41.1% of patients at 5 years, while moderate visual loss (loss of ≥ 3lines) occurred in 25% of patients. Independent risk factors associated with good visual outcome included good VA (≥20/40) at start (OR = 8.68, p<0.001,), younger age (OR= 3.52,p<0.05,), and smaller lesion size on both indocyanine green (ICG) (4.37mm2 vs. 11.11mm2,p=0.007) and fluoroscein angiography (FA) (9.85mm2 vs. 19.96mm2, p=0.021). Poor visual outcomes (final VA ≤20/200) were associated with poor initial VA at presentation (OR = 6.06, p<0.05,) and the presence of significant leakage on angiography (30.8% vs. 3.8%, p=0.024).
Conclusions: :
In a multi-ethnic Asian population, PCV has a moderate clinical course. The independent risk factors for good visual outcome were younger age, good presenting VA and lesion size, while leakage on angiography conferred a higher risk for poor visual outcome.
Keywords: clinical (human) or epidemiologic studies: natural history • clinical (human) or epidemiologic studies: risk factor assessment • choroid