Our Journey in Diagnosis and Treatment of Polypoidal Choroidal Vasculopathy with Optical Coherence Tomography and Fundus Photography

Author: Saadet Gültekin Irgat

Co-authors: Alpaslan Koc, Fatih Ozcura Ozcura

Abstract

purpose:Sharing the changes in optical coherence tomography (OCT) findings after 12 months of treatment of cases that may be compatible with the diagnosis of polypoidal choroidal vasculopathy (PCV) with the help of OCT and fundus photography (FP) in the absence of indocyanine green angiography
Setting:This study retrospective study conducted at Kutahya Health Science University School of Medicine
Methods:A single eye of 28 cases who had not received treatment before with PCV was included in the study. Complete ophthalmological examinations of the cases were performed. OCT, FP, FA findings of the cases were evaluated by 2 retina specialists. Patients with three or more of the following OCT and FP findings were evaluated as PCV; Complex or multilobular pigment epithelial detachment (PED), sharp peaked PED, subretinal pigment epithelial (RPE) ring–like lesion, double-layer sign, fluid compartment, orange nodule, massive subretinal hemorrhage. Due to the necessity in our health system, 3 doses of bevacizumab and then aflibercept treatment were administered intravitreally at intervals of 6-8 weeks. OCT changes at 3 and 12 months of treatment and the patients' measurement of best-corrected visual acuity (BCVA) using a Snellen chart that was converted to logarithm of minimal angle of resolution(logMAR) equivalent.Evaluated OCT properties; Presence of subretinal and intraretinal fluid, accompanying PED, PED height, PED type (predominantly serous and predominantly fibrovascular).
Results:The mean age of the patients was 72.50±10.54 (52-84) and 56% were male. Subretinal fluid (SRF)on OCT was quite common at baseline (92.9%), significantly reduced to 39.3% and 25.0% at 3 months and 12 months, respectively. There was less intraretinal fluid (IRF) at baseline (14.3%). However, the proportion of polyps with IRF on them was 7.1% at month 3 and month 12, respectively. PED was almost universally present at baseline (89.3%) and continued to subside at 3 and 12 months (78.6% and 53.6%, respectively). There was a gradual decrease in the maximum PED height (276.5 µm at baseline, 195.4 µm at 3 months, and 107.7 µm at 12 months, P< 0.001). The reflectivity of the PED content also changed, with a significant reduction in serous content (28.6% at baseline, 10.1% at 3 months, and 3.6% at 12 months) and sub RPE ring-like lesion (64.5%, 46.4%, and 25%,p< 0.05). At the end of 12 months, CMT decreased from 479.57 µm to 362.42 µm (p< 0.001), while BCVA increased from logMAR 0.61±40 to 0.49±32 (p< 0.001).
Conclusion:It is important in the diagnosis and treatment of the disease that subretinal fluid and PED lesions, which often accompany polypoidal lesions, can be followed up, especially with OCT. FP can be helpful in the diagnosis phase.
In the absence of indocyanine green angiography, OCT and FP are promising in guiding the diagnosis and teherapy.No have financial relations.