Conversion of wet AMD into polypoidal choroidal vasculopathy Among 20 patients with typical wet age-related macular degeneration (AMD) in one eye and polypoidal choroidal vasculopathy (PCV) in the other eye, 10 (50%) of the eyes with typical AMD developed PCV during an average follow-up period of 21.7 months, according to a new study.

PCV is a distinct clinical entity that is characterized by polypoidal vasculature with interconnecting choroidal vessels. It has been proposed that PCV may be a variant of neovascular AMD. AMD and PCV may coexist in the same eye. Because the PCV vascular lesions progress beneath the retinal pigment epithelium (RPE), to diagnose PCV successfully, use of indocyanine green angiography (ICGA) is critical.

All cases underwent fluorescein and indocyanine green angiography (FA and ICGA) at the initial examination. All PCV cases were diagnosed definitively based on characteristic aneurysmal lesions seen on ICGA. Follow-up examinations also were conducted to determine whether polypoidal lesions had developed in the eyes with typical AMD.

Among 349 patients with neovascular AMD, 20 (5.7%) had one eye with PCV and the other eye with typical AMD. The average age was 73 years. The mean best-corrected visual acuity levels at the initial examination in eyes with PCV and typical AMD were 0.20 and 0.43, respectively (p = 0.09). All subgroups of classic and occult CNV were observed in the eyes with typical AMD on FA. During the follow-up period (average, 21.7 months), PCV developed in ten eyes with typical AMD at the initial examination.

The investigators conclude that although some cases might include different stages of progression or probable cases of PCV, the combined cases in which one eye has PCV and the other eye has typical AMD suggest that those clinical entities are not independent and possibly overlap.

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Graefes Arch Clin Exp Ophthalmol. 2010 Jan 14. [Epub ahead of print]