This 60 YO female presented with counting fingers vision from a large central and superior submacular hemorrhage.
OCT scanning shows variable subretinal blood and subretinal fluid along with an RPE detachment. There are no drusen.
Pars plana vitrectomy with drainage of the subretinal blood was performed. TPA was not used. Postoperatively, there is virtually no blood. OCT scanning shows no subretinal blood or fluid. Variable outer retinal cystic changes and atrophy are noted, along with a residual RPE detachment. Vision was 20/120.
Learning Points:
Polypoidal choroidal vasculopathy (PCV) is a variant of type 1 macular neovascularization. PCV is likely distinct from age-related macular degeneration, occurring in a different population (more common in African Americans and Asians), with a relative lack of drusen and a thicker choroid.
The sub-RPE vessels were classically characterized using indocyanine green angiography, although recent literature suggests that OCT is just as effective at diagnosing these vascular polyps. Historically, these lesions were believed to be somewhat resistant to anti-VEGF monotherapy and often required combined treatment with photodynamic therapy. More recent data from the PLANET study suggest that Eylea monotherapy is also effective (AJO 2019;204;80-89).
