Polypoidal Choroidal

33 %
67 %
Information about Polypoidal Choroidal
Education

Published on March 21, 2014

Author: badhon821

Source: slideshare.net

Polypoidal Choroidal Vasculopathy Dr. Md Mominul Islam Fellow Vitreo - Retina

Introduction  PCV is an exudative maculopathy with features similar to neovascular AMD with hemorrhage, pigment epithelium detachment and neurosensory detachment.  Pathogenesis mostly unknown  It remains controverial as to weather PCV represents a sub type of neovascular AMD

History • In 1982 By Yannuzzi et al • At annual meeting of American academy of ophthalmology as :-  Polypoidal , subretinal, vascular lesions associated with serous and hemorrhagic detachments of the RPE in a series of patients (10/11 patients were woman).  The entitity was initially called Idiopathic polypoidal choroidal vasculopathy.

History (contd) In 1984 Kleiner et al Described as:-  A peculiar hemorrhagic disorder of the macula and sub retinal pigment epithelium bleeding in middle aged black woman ,which they term posterior uveal bleeding syndrome.  Later a study from the same group of authors showed an expanded clinical spectrum for PCV

Pathogenesis  It is a primary abnormality of the choroidal circulation, characterized by :-  An inner choroidal vascular network of vessels ending in an aneurysmal bulged or outward projection often visible as a reddish – orange, spheroid ,polyp like structure.  PCV primarily involves the inner choroidal vasculature that is well differentiated from the middle and larger choroidal vessels by histology.

Histopathological Features  Kuroiwa reported from surgically excised specimens from 5 patients with PCV had been diagnosed by ICGA :--  Results - arteriosclerosis appears to be an important pathological feature in the choroidal vessels of PCV subjects.

Histopathological Features (Contd) In another histopathologic group : • Nakashizuka et al, who also examined from surgically excised specimens from 5 patients with PCV Results :- little granulation tissue from any of the specimens. On the other hand all the specimen exhibited:- • Massive exudative change and leaking ,all the vessels exhibited hyalinization and chorio-capillaris had disappeared ,in which RPE had been preserved.

Immuno ChemistryThis group demonstrated that : • PCV is not the same as choroidal neovascularization. • CD-34 is a marker of vascular endothelial growth factor • CD-34 staining revealed  Discontinuity in the vascular endothelium.  Smooth muscle actin was negative in hyalinized vessels  There was disruption and injury of smooth cells causing dilation of vessels

Demography Prevalence of PCV in presumed neovascular AMD • US -7.8% • Belgian – 4.0% • Italian - 9.8 % • Greek – 8.2% • Japanese – 23.0-54.7% • Chinese – 22.3% • Korean – 24.6%

Demography (contd)  Varies with age  Predominantly middle aged ,one or two decade earlier than classical AMD  Commonly occur both gender ( more in Asian man than woman)  More prevalent in black, Japanese and other Asian than in white.  Incidence is high in Asian.

Course Natural course of disease is Variable:-  May be relatively stable  May repeated bleeding and leakage with vision loss and chorioretinal atrophy  With or without fibroitic scarring  Reddish- orange nodules alone or nodule and small sub- retinal hemorrhage and absence of hard exudates.  May association with other condition like thrombocytopenia and massive hemorrhage has been reported  Also association with sickle cell disease and irradiation.

Clinical feature Usually bilateral  Protruding orange –red elevated lesion often with nodular elevations of RPE.  Also described as –  Polypoidal lesion ,polyp like or grasp like  Association serous exudation and hemorrhage , that may lead to detachment of the RPE and sometimes neurosensory retina  Sometime associated features recurrent hemorrhage and vitreous hemorrhage.

Clinical feature (contd) Location of the lesion:  In the macular area -69.5%  Under the temporal retinal vascular arcade 15%  Peripapillary area (within one disc diameter of disc edge -4.5%.  Also mid peripheral area

Clinical feature (contd)Lesions may active or inactive. • Lesions considered as active on the evidence of clinical, OCT, FFA any one of the following: 1. Vision loss of 5 or more letters (ETDRS chart) 2. Subretinal fluid with or without intraretinal fluid. 3. PED 4. Subretinal hemorrhage or fluorescence leakage.

ICGA :- • Accepted as the gold standared for diagnosis of PCV. • Better visualization in ICGA than FFA  ICG absorbs and emit near infrared light, which readily penetrates the RPE and enhancing veiwing of choroidal lesions  ICG binding affinity with plasma proteins, that means – it does not leak from chorio-capillaries in the same way as fluorescence, so choroidal lesions are less obscured.

Characteristics feature of PCV in ICGA:-  A branching network of inner choroidal vessels.  Nodular polypoidal aneurysm or dilations at the edge of these abnormal vessels network, which correspond to orange sub-retinal nodules.  Presence of single or multiple focal nodular areas of hyperfluorescence arising from choroidal circulation within the first 6 minutes

Classification According to Japanese group on PCV Quiescent: Polyps in the absence of subretinal or intraretinal fluid or hemorrhage. Exudative : Exudation without hemorrhage, which may include sensory retinal thickening, Neuro-sensory retinal detachment, PED, subretinal lipid exudation. Hemorrhagic: Any hemorrhage with or without other exudative characteristics

Differential Diagnosis  AMD  CSCR

Treatment Thermal laser Photocoagulation: To be beneficial ,albeit it with short term follow up and for extra foveal lesion. In some studies  Improve and stabilize vision- in 55-100%  Vision loss – in 13-45%  Whole lesion compared with polyps only appears to be more efficacious.

Photodynamic therapy:  Regression or resolution of the polyp by in angio occlusive mechanism of action  Restrict loss of letters on ETDRS chart to less than 15 letters or improved vision 80-100% patient after 1 year.

Anti VEGF therapy:  Intravitreal Ranibizumab resolving the macular oedema, polypoidal complexes decreased in 4/12 (33%) eyes.  Intravitreal Bevacizumab 1/11 (9.09%) eyes

Combination therapy:  Both combination therapy and vertiporfin PDT monotherapy superior to ranibizumab monotherapy in achieving complete polyp regression at 6 months.  Improvement in BCVA and central retinal thickness also favored combination therapy.

THANK YOU

Add a comment

Related presentations

Related pages

Polypoidal Choroidal Vasculopathy - EyeWiki

Polypoidal choroidal vasculopathy (PCV) is a disease of the choroidal vasculature. It is present in both men and woman of many ethnicities, characterized ...
Read more

Polypoidal choroidal vasculopathy in Caucasians.

PURPOSE: To study the prevalence of polypoidal choroidal vasculopathy (PCV) in Caucasian patients with occult choroidal neovascularization (CNV); to study ...
Read more

Polypoidal choroidal vasculopathy: evidence-based ...

BACKGROUND: Polypoidal choroidal vasculopathy (PCV) is an exudative maculopathy affecting vision, with clinical features distinct from neovascular age ...
Read more

Eye - Polypoidal choroidal vasculopathy: an angiographic ...

Top of page Abstract. The understanding of polypoidal choroidal vasculopathy has evolved rapidly in the past three decades. The hallmark of the disease is ...
Read more

Idiopathic Polypoidal Choroidal Vasculopathy of the Macula

Idiopathic Polypoidal Choroidal Vasculopathy of the Macula RamanaS.Moorthy,MD,1AliceT.Lyon,MD,2MauriceF.Rabb,MD,3RichardF.Spaide,MD,4 Lawrence A. Yannuzzi ...
Read more

Polypoidal Choroidal Vasculopathy (PCV) - EyeRounds

Polypoidal Choroidal Vasculopathy is more common in Asian populations. The most common presenting symptom in PCV is decreased visual acuity (VA) due to SRF ...
Read more

Retina Today - Treatment of Polypoidal Choroidal ...

Treatment of Polypoidal Choroidal Vasculopathy. Individualized plans may be warranted, as the disease course can vary. By Won Ki Lee, MD
Read more

Polypoidal Choroidal Vasculopathy | JAMA Ophthalmology ...

Objective To clarify the incidence, demographic features, and clinical characteristics of polypoidal choroidal vasculopathy (PCV) in Japanese patients.
Read more

Polypoidal Choroidal Vasculopathy: Clinical Features and ...

Polypoidal Choroidal Vasculopathy Ophthalmologica 2014;231:59–74 DOI: 10.1159/000355488 61 ings at the initial visit may vary depending on when the
Read more

Polypoidal Choroidal Vasculopathy: A Review - Survey of ...

More than a quarter century has passed since the original description of polypoidal choroidal vasculopathy (PCV) in 1982 as a peculiar hemorrhagic disorder ...
Read more