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xiaoling liu, Haojie Fu; A Novel Group of mid-Peripheral Polypoidal Choroidal Vasculopathy with Diffuse RPE Atrophy. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2405. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
We described a novel group of mid-peripheral PCV cases in which the PCV lesions coexisted with the mid-peripheral retinal pigment epithelium (RPE) atrophy.
A retrospective observational case series from 2013 to 2016 was conducted at Eye Hospital of Wenzhou Medical University. 106 consecutive patients (120 eyes) were diagnosed as PCV through reading fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) and sorted out in Heidelberg HRA-II system. Their clinical histories and angiographic images were carefully reviewed.
17 cases (26 eyes, 9 bilaterally involved) were determined as the mid-peripheral PCV from all 106 PCV patients (17/106, 16.0%). Among them, 9 cases were bilaterally involved (9/17, 52.9%), and 15 were male (15/17, 88.2%). The mean age was 77.5 years old (SD = 3.0). The mean visual acuity was 1.0 LogMAR (SD = 0.8). The cardinal features of mid-peripheral PCV included: 1. The mid-peripheral polys coexisted with patchy RPE atrophy (paving-stone-like). 2. The RPE atrophic lesion encircled the posterior pole. Interestingly, some of them merged with each other, forming an annular lesion (Figure1-B). 3. The active polyps (85%) were often found lying between the atrophic and relatively healthy RPE, beneath which staining of choriocapillaris was found through the late ICGA. 4. Some of the polyps had a tendency to progress and recur, and even worse, to invade the macula, which induced severe vision loss.
The mid-peripheral PCV is distinguished from the idiopathic PCV and polypoidal CNV by its location and concomitant RPE atrophy. The paving-stone-like atrophic RPE lesion, along with the underlying choroid disturbance, indicates a long-standing and chronic pathologic course. Regarding these features, we believe that it is a distinct group of PCV, which has not been proposed before.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Figure 1. A. fundus color photograph. B. FFA showed paving stone like RPE atrophy lesions (red arrowhead) encircling the posterior pole. C. In the mid-stage of ICGA, multifocal polyps (yellow arrowheads) were found in the temporal quadrant. D. Late frames of ICGA showed stained choriocapillaris (black arrowheads) in the mid-peripheral retina.
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