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   Table of Contents      
PHOTO ESSAY
Year : 2016  |  Volume : 64  |  Issue : 5  |  Page : 391-392

Imaging for branching vascular network in polypoidal choroidal vasculopathy


1 Department of Vitreoretina, Shri Bhagwan Mahavir Vitreoretina Services, Chennai, Tamil Nadu, India
2 Department of Vitreoretina, Aditya Birla Sankar Nethralaya, Kolkata, West Bengal, India

Date of Submission02-Nov-2015
Date of Acceptance03-Apr-2016
Date of Web Publication6-Jul-2016

Correspondence Address:
Dr. Rupak Roy
Aditya Birla Sankara Nethralaya, 147, Mukundapur, E. M. Bypass, Kolkata - 700 099, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.185616

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Keywords: Branching vascular network, enhanced depth imaging optical coherence tomography, indocyanine green angiography, polypoidal choroidal vasculopathy


How to cite this article:
Vyas C, Kumar S, Roy R. Imaging for branching vascular network in polypoidal choroidal vasculopathy. Indian J Ophthalmol 2016;64:391-2

How to cite this URL:
Vyas C, Kumar S, Roy R. Imaging for branching vascular network in polypoidal choroidal vasculopathy. Indian J Ophthalmol [serial online] 2016 [cited 2020 May 29];64:391-2. Available from: http://www.ijo.in/text.asp?2016/64/5/391/185616

Polypoidal choroidal vasculopathy (PCV) is characterized by multiple serosanguineous retinal pigment epithelium (RPE) detachments with abnormal choroidal vasculature as seen on indocyanine green (ICG) angiography. [1],[2]

We describe a case of a 52-year-old female with dimness of vision for 7 months in the left eye (best-corrected visual acuity 20/200). Fundus examination showed serosanguineous RPE detachment with orange-red polypoidal lesions [[Figure 1] red arrowheads]. ICG angiography revealed hot spots suggestive of polyps [[Figure 2] red arrowheads] and a large feeder vessel with a branching vascular network (BVN) [[Figure 2] white arrowheads]. Enhanced depth imaging optical coherence tomography (OCT) scan through the BVN showed areas of hyperreflective RPE undulations [[Figure 3] asterisks] representing the vascular network and the presence of moderately hyperreflective polypoidal lesions adherent to its undersurface [[Figure 4] red arrowheads]. The characteristic "double layer sign" was noted between two highly reflective membranes [Figure 4]. [3]
Figure 1: Color fundus image showing an orange-red polyp (red arrowheads)


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Figure 2: Indocyanine green angiography photo showing feeder vessels with branching vascular network (white arrowheads) with hyperfluorescent polyps (red arrowheads)


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Figure 3: Enhanced depth imaging spectral-domain optical coherence tomography image showing areas of retinal pigment epithelium undulations representing branching vascular network (asterisks)


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Figure 4: Enhanced depth imaging spectral-domain optical coherence tomography image showing polyps adherent to the undersurface of hyperreflective retinal pigment epithelium (red arrowheads) "pearls on a string" appearance with characteristic "double layer sign" noted between two highly reflective layers consisting of the hyperreflective detached retinal pigment epithelium and Bruch membrane


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  Discussion Top


PCV is diagnosed by the presence of subretinal focal ICG hyperfluorescence, plus at least one of the angiographic or clinical criteria, i.e., a nodular appearance when viewed stereoscopically, BVN, pulsatile polyp, presence of hypofluorescent halo, orange subretinal nodule, and massive submacular hemorrhage. [4]

BVN is seen as a highly reflective undulation of the RPE on OCT scan with the presence of PCV structures adherent to the undersurface of this elevated pigment epithelial detachment resembling the appearance of "pearls on a string." [3],[4]

PCV lesions and the associated Type 1 neovascular lesions are located within or above Bruch membrane, usually in association with an RPE detachment. The presence of this neovascular tissue between the hyperreflective RPE band and the hyperreflective remainder of Bruch membrane and inner choroid creates the characteristic OCT "double layer sign" as described by Sato et al. [3]

This Photo Essay highlights the salient diagnostic ICG angiography and OCT features in PCV.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Yannuzzi LA, Sorenson J, Spaide RF, Lipson B. Idiopathic polypoidal choroidal vasculopathy (IPCV). Retina 1990;10:1-8.  Back to cited text no. 1
    
2.
Yannuzzi LA, Ciardella A, Spaide RF, Rabb M, Freund KB, Orlock DA. The expanding clinical spectrum of idiopathic polypoidal choroidal vasculopathy. Arch Ophthalmol 1997;115:478-85.  Back to cited text no. 2
    
3.
Sato T, Kishi S, Watanabe G, Matsumoto H, Mukai R. Tomographic features of branching vascular networks in polypoidal choroidal vasculopathy. Retina 2007;27:589-94.  Back to cited text no. 3
    
4.
Koh A, Lee WK, Chen LJ, Chen SJ, Hashad Y, Kim H, et al. EVEREST study: Efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy. Retina 2012;32:1453-64.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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