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52 year old Filipino female with decreased vision OD for two weeks
Digital Journal of Ophthalmology 1998
Volume 4, Number 17
April 18, 1998
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Everett Ai, MD | California Pacific Medical Center, San Francisco, CA Haris I. Amin, MD | California Pacific Medical Center, San Francisco, CA
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| Diagnosis and Discussion | Idiopathic Polypoidal Choroidal Vasculopathy
Idiopathic Polypoidal Choroidal Vasculopathy has also been called the posterior uveal bleeding syndrome and multiple recurrent serosanguineous RPE detachments in Black women. IPCV typically affects women in their fifth to seventh decades. Darker skinned individuals are affected more than Caucasians. There is no association with features seen in high myopia (lacquer cracks), ARMD (soft drusen), or ocular inflammation. IPCV is usually bilateral.
There are two characteristic findings. A sub RPE branching network which is usually below the papillomacular bundle but can be isolated below the fovea, as demonstrated in the left eye of this case. Reddish-orange nodules, called choroidal excrescences, are found at the edge of the networks.
Recurrent exudation and hemorrhage can occur under the RPE or retina. Breakthrough bleeding INTO the vitreous is possible. Over time, the orange mass like lesions flatten with resolution of the PED. New tubular vessels emanate FROM the flattened orange lesion.
Fluorescien angiography shows filling of IPCV lesions with the choroidal vasculature. There is blocked fluorescence due to hemorrhage, exudate or the RPE. IPCV vessels can leak, though not as much as in a choroidal neovascular membrane seen in ARMD. The polypoid structures are hyperfluorescent and stain or leak on late frames.
Indocyanine green angiography shows that IPCV vessels fill slower than choroidal vessels. The network of abnormal vessels is also larger than suspected clinically. The polypoid structures leak dye slowly.
Vision is typically better in IPCV than in ARMD and vision can be improved with treatment of the lesions. In some cases, scarring can occur with attendant visual loss. Treatment is carried out to areas of leakage FROM the choroidal excrescences.
IPCV can be differentiated FROM ARMD in the following ways. ARMD patients are usually Caucasian. They usually have typical drusen and RPE changes which are often bilateral. The vessels seen in CNV due to ARMD are not clinically visible. There is frequent scarring. | |
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