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POLYPOIDAL CHOROIDAL VASCULOPATHY ASSOCIATED WITH CENTRAL SEROUS CHORIORETINOPATHY: Pachychoroid Spectrum of Diseases

Manayath, George, J., FRCS; Shah, Vanee, Sheth, MS, FICO; Saravanan, Veerappan, R., FRCS; Narendran, Venkatapathy, DNB

doi: 10.1097/IAE.0000000000001665
Original Study

Purpose: To study multimodal imaging features of polypoidal choroidal vasculopathy (PCV) associated with central serous chorioretinopathy (CSC) in the same eye.

Methods: A retrospective observational study of cases of suspected PCV which underwent indocyanine green angiography, fundus fluorescein angiography and optical coherence tomography was done, to look for simultaneous typical CSC-like active leak in the same eye. The relevant history, best-corrected visual acuity, optical coherence tomography, fundus fluorescein angiography, and indocyanine green angiography findings were analyzed.

Results: From 226 patients reviewed, 195 patients had PCV from which 6 eyes (3.07%) with features of PCV associated with typical CSC-like active leak in the same eye were identified; 3 men and 3 women with a mean age of 62.6 years. Optical coherence tomography showed notched pigment epithelial detachment in two and irregular peaked pigment epithelial detachment in four cases with subretinal fluid and/or subretinal haemorrhage over a thick choroid with dilated outer choroidal vessels. Fundus fluorescein angiography showed stippled hyperfluorescence at polyp area and a separate typical CSC-like active leak—Inkblot in three and Smokestack in three cases. On indocyanine green angiography, multiple polyps were noted with choroidal hyperpermeability in late phase at the site of CSC leak.

Conclusion: The coexistence of PCV with typical CSC-like active leaks and a thick choroid in the same eye simultaneously provides strong evidence that these diseases have an association and support the hypothesis that these conditions may originate from predisposed thick choroid.

Recently, the visualization of choroid has become better with the newer imaging modalities. In the literature, there are reports linking polypoidal choroidal vasculopathy and central serous chorioretinopathy. In this study, typical central serous chorioretinopathy–like active leaks on fluorescein angiography and active polyps on indocyanine green angiography are documented in different locations in the same eye simultaneously, over a thick choroid (pachychoroid) by multimodal imaging.

Department of Vitreoretina services, Aravind Eye Hospital, Coimbatore, India.

Reprint requests: Vanee Sheth Shah, MS, FICO, Department of Vitreoretina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Avinashi Road, Coimbatore 641014, Tamilnadu, India; e-mail: vanee.sheth@gmail.com

None of the authors has any financial/conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.