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M. F. Maldonado, N. G. Ghazi; Demonstration of Polyps in Polypoidal Choroidal Vasculopathy by High Definition Spectral Domain Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4386.
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© ARVO (1962-2015); The Authors (2016-present)
To report for the first time direct visualization of a polyp using high definition, spectral domain optical coherence tomography (HDSD-OCT) in polypoidal choroidal vasculopathy (PCV).
A 62-year-old Hispanic female presented with a two-week history of decreased vision in the left eye. Examination disclosed a best-corrected visual acuity of 20/200, associated with peripapillary intraretinal and subretinal hemorrhage and submacular fluid. In addition to a complete eye exam, her evaluation included fluorescein angiography (FA), indocyanine green (ICG) videography and HDSD-OCT of the macula and peripapillary area using a Heidelberg Spectralis unit.
A large round polypoidal structure with an associated network of choroidal vessels was observed in the peripapillary area on angiography. The macular OCT cross-sectional images and three dimensional constructs disclosed intraretinal and subfoveal fluid. The peripapillary OCT disclosed an atypical pigment epithelial detachment (PED) with a subjacent round and well-defined circular structure with low internal reflectivity compatible with a vascular cavity. The latter was most apparent on the OCT line scan transecting the polyp noted on angiography. OCT- and angiography-guided focal laser therapy was performed to the polyp only. Following treatment, the polyp was completely occluded as evidenced by angiography and OCT. This polyp occlusion was associated with resolution of the subretinal and intraretinal fluid and improvement of the visual acuity to 20/50.
Although several reports exist in the literature describing OCT changes and the atypical associated PED in PCV, to our knowledge, this report is the first peer-reviewed medical literature documenting the actual polypoidal structures by HDSD-OCT. HDSD-OCT may also be useful in monitoring treatment effect.
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