IDIOPATHIC POLYPOIDAL CHOROIDAL VASCULOPATHY OF THE MACULA

Objective: The authors evaluated the clinical, fluorescein, and indocy anine green (ICG) angiographic characteristics of the macular variant of idiopathic polypoidal choroidal vasculopathy (IPCV). Design: Observ ational case series. Participants: The records, photographs, and fluor escein and ICG angiograms of eight eyes of seven patients with IPCV le sions confined to the macula were reviewed. Main Outcome Measures: The visual acuity, fundus examination, fluorescein and ICG angiographic c haracteristics, and clinical course were compared. Results: All patien ts demonstrated polypoidal lesions arising from macular choroidal vess els on ICG angiography. One patient had bilateral lesions. These lesio ns appeared hyperfluorescent in the early phases of both fluorescein a nd ICG angiography. Late-phase leakage was seen in cases associated wi th subretinal fluid or exudate. None of these patients demonstrated po lypoidal lesions arising from the peripapillary choroidal circulation or peripapillary choroidal neovascularization. Three eyes with polypoi dal lesions that were associated with subretinal fluid and exudates we re treated with photocoagulation. Five eyes were not treated. Final vi sual acuity ranged from 20/20 to hand motions. Severe visual loss was associated with vitreous and subretinal hemorrhage, but this resolved without permanent severe visual loss in several cases. Conclusions: In the macular variant of IPCV, ICG and fluorescein angiography demonstr ate characteristic macular polypoidal lesions without evidence of peri papillary lesions. The vascular origin of these polypoidal lesions app ears to be the macular choroidal circulation. This is distinguished fr om classic IPCV, in which lesions appear to arise from the peripapilla ry choroidal circulation. Visual prognosis appears to be good, with mo st patients retaining visual acuity of 20/80 or better. If subretinal fluid or exudates reduce visual acuity, photocoagulation should be con sidered.