Polypoidal choroidal vasculopathy in exudative and haemorrhagic pigment epithelial detachments

Aims-To determine the prevalence of polypoidal choroidopathy in consecutive patients presenting with large haemorrhagic and exudative neurosensory ret inal and retinal pigment epithelial detachments (PEDs) of over 2 mm in diam eter in the absence of drusen. Methods-40 patients were identified over a 5 month period of which 29 had h aemorrhagic detachments, and 11 had purely exudative detachments. All had i ndocyanine green (ICG) angiography, and the presence was sought of large bl ood vessels in the choroid associated with localised dilated terminals that filled slowly and leaked ICG. Results-In 34 cases (85%) there was an appearance consistent with previous descriptions of idiopathic polypoidal choroidal vasculopathy. Of the six wi thout polypoidal lesions the disorder was attributed to choroidal neovascul arisation in four, chorioretinitis in one, and a fibrovascular FED in one. Of those with polypoidal lesions 20 (65%) were female, the mean age was 65. 4 years (range 44-88), and 25 (74%) were white, seven (20%) black, and two (6%) east Asian. Eight had a history of hypertension. Visual acuity varied from 6/6 to counting fingers in the involved eye (mean 6/24). Bilateral pol ypoidal choroidal lesions were demonstrated in 16 patients (47%). The predo minant location for these lesions was the macular region in 23 patients (68 %). Polypoidal vasculopathy was found in 16 patients (47%) who had a previo us diagnosis of age related macular disease (AMD). No patients had evidence of intraocular inflammation. Conclusions-In a largely white patient population a high proportion of pati ents with haemorrhagic and exudative PEDs has evidence of polypoidal lesion s on ICG angiography.