Polypoidal choroidal vasculopathy examined with en face optical coherence tomography


Dr Akitaka Tsujikawa, Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan. Email: tujikawa@kuhp.kyoto-u.ac.jp


Background:  To study the morphologic features of polypoidal choroidal vasculopathy (PCV) with the use of en face optical coherence tomography (OCT).

Methods:  We reviewed retrospectively 57 eyes of 57 patients with PCV. The macular region was examined with OCT en face planes scanned at different sequential depths, following which detailed scanning was performed of arbitrarily selected longitudinal planes.

Results:  In 48 of the cases (84.2%), en face OCT allowed us to detect round protrusions of the retinal pigment epithelium (RPE) that corresponded to the polypoidal lesions seen on indocyanine green angiography (ICGA); the branching vascular networks seen on ICGA often induced slight elevation of the overlying RPE, which typically assumed a geographical shape. In 30 cases (52.6%), branching vascular networks were detected as elevations of the RPE. With en face OCT, serous pigment epithelial detachments, most of which were seen as round protrusions of the RPE, were often accompanied by adjacent smaller round protrusions of the RPE, consistent with polypoidal lesions. These protrusions of the RPE were often fused and typically appeared as a ‘snowman’. Subsequent longitudinal examination revealed the polypoidal lesions to be sharp protrusions of the RPE with moderate inner reflectivity. Consistent with the location of the branching vascular network, a highly reflective line was seen often just beneath the slightly elevated reflective line of RPE.

Conclusions: En face examination using OCT has an advantage in screening lesions of PCV and in examination of the detailed relationship of each component of these lesions.