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M. Quaranta, M. Mauget–Faÿsse; Evolutional Classification of Idiopathic Polypoidal Choroidal Vasculopathy According to Fluorescein Angiographic and OCT Findings . Invest. Ophthalmol. Vis. Sci. 2005;46(13):226.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: In Idiopathic Polypoidal Choroidal Vasculopathy (IPCV), polypoidal vascular abnormalities (PVA) can pass through 3 evolutional stages: early quiescent, active exudative and late scar. The purpose was to identify the pathognomonic characteristics of fluorescein angiography (FA) and OCT scans in each stage. Methods: Consecutive patients with angiographically (FA and ICG–A) proved IPVC were also submitted to OCT serial scans in order to obtain the OCT profile of each PVA seen of FA and ICG–A. The results were correlated with the evolutional stages of the PVAs. Results: Forty patients with IPVC, 37 with active exudative and 3 with early quiescent form were included in the study. 30 exudative IPVC received photodynamic therapy with Visudyne on the whole retrofoveal area occupied by the PVA and the interconnecting neovascular network, 6 received laser photocoagulation on the exudative extrafoveal PVA, and one denied treatment. After a follow–up period ranging from 6 weeks to 12 months, 63% of PVA (19/30 pts) were at the scar stage and 1 spontaneously resorbed the quiescent PVA without any clinical sequel . Quiescent PVAs were visualized as early and late hyperfluorescent spots on FA; on OCT scans they appeared as dome–like, optically empty elevations of the RPE/CC complex. Active exudative PVAs on FA were early hyperfluorescent and late leaking spots always associated with late pin–points surrounding the active PVA. On OCT scans, they were visualized as circumscribed elevations of the RPE/CC complex with an irregular subretinal profile an optically midly–reflective inhomogeneous filling. Retinal and/or PED detachments were always visualized. Scar PVAs were angiographically not differentiated from the other RPE disturbances due to the disease. On OCT, the elevation of the RPE/CC complex reduced and filled with highly–reflective material and finally resorbed leaving place to a zone of inner retinal disorganisation with an underlying RPE/CC atrophy. Conclusions: Fluorescein angiography and OCT with their pathognomonic features allow to classify the evolutional stage of IPCV giving fundamental elements to decide the most appropriate management of IPVC.
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