Polypoidal Choroidal Vasculopathy – A Type I Polypoidal Subretinal Neovasculopathy
A 47 year old Filipino female presented with the sudden onset of decrease in vision in the right eye in 1998. Visual acuity was: OD 20/70 OS 20/20. Fundus exam showed large orange subretinal vascular structures in the extrafoveal region with serous detachment in the fovea (Fig. ). ICG angiography showed a temporal branching vascular network with extrafoveal polyps (Fig. ). This eye underwent macular laser and has maintained 20/20 vision after 14 years. The ICG angiogram of the left eye showed a completely normal choroidal vasculature without a PCV complex (Fig. ).\nThirteen years later in 2011 the patient noted the sudden onset of a black and grey spot in the left eye for 2 weeks. ICG angiography confirmed the presence of a new peripapillary polypoidal vascular complex (Fig. ), that was not present on ICG angiography 13 years earlier. Optical coherence tomography corresponding to the polyps showed that the subretinal neovascular complex lies above Bruch’s membrane and below the retinal pigment epithelium (Fig. ). This patient was treated with intravitreal 2.0 mg ranibizumab in the PEARL2 study with remarkable resolution of the large vascular polyps, the retinal pigment epithelial detachment, the serous retinal detachment, and the branching vascular network (BVN) (Fig. ).