Choroidal Venous Pulsations at an Arterio-venous Crossing in Polypoidal Choroidal Vasculopathy
A 66-year-old Japanese woman was referred to us with a 6-month history of decreased vision and metamorphopsia in the left eye. Visual acuity was 20 / 16 for the right eye and 20 / 32 for the left eye. Fundus examination showed mild epiretinal membrane in the macula of the right eye, and an elevated, oval, 1-disc-diameter, reddish-orange lesion accompanied by serous detachment of the neurosensory retina in the macula of the left eye (). During the choroidal arteriolar filling phase of ICG angiography (HRA2; Heidelberg Engineering, Heidelberg, Germany), branching vessels (arterioles) appeared in blocked fluorescence, and a few dilated choroidal venules with dye leakage manifested in the early choroidal venular filling phase (). The dye proceeded extremely slowly in the choroidal venules, leaking to form polypoidal vessels. Notably, the early choroidal venular filling phase revealed pulsatile movements as subtle rhythmic variations in the caliber of the choroidal venule at an A-V crossing (, yellow arrowhead), where the venule (, blue arrowheads) crossed over the arteriole (, red arrowheads). In the later choroidal venular filling phase, the polypoidal lesion filled with dye (). Her left eye was diagnosed as PCV and treated with photodynamic therapy using verteporfin (Visudyne; Novartis AG, Basel, Switzerland) according to the standard protocol (698-nm laser system, 50 J/mm2, 83-s exposure time, 2,650 µm spot size). Within 3 months after treatment, the polypoidal vessel ceased to leak and the pulsation vanished (). The reddish-orange lesion gradually decreased in size with complete disappearance of the retinal detachment ().