This 59YO female patient presented with variable mostly peripheral submacular blood in her right eye and counting fingers vision. Optos imaging shows the extent of the subretinal blood, which is dark superiorly and yellow inferiorly.
Triton swept-source OCT shows variable outer retinal and subretinal hyperreflective material from resolved submacular blood, and this is seen clinically as the coarse subretinal pigment most evident in the inferotemporal macula. A large RPE detachment (PED) is seen superiorly in the vertical scan, with a smaller PED nasally in the horizontal scan.
Fluorescein angiography shows mostly blockage from the subretinal blood. Several small asymptomatic polyps are noted superior to the left nerve.
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, often requiring combined treatment with photodynamic therapy.
More recent data from the PLANET study suggest that Eylea monotherapy is also effective (AJO 2019;204:80-89).
