Polypoidal choroidal vasculopathy pattern in age-related macular degeneration - A clinicopathologic correlation

Purpose: To report the histopathologic features of surgically removed subma cular tissue from an elderly patient with a pattern of polypoidal choroidal vasculopathy on indocyanine green angiography. Methods: Clinical examination including fluorescein and indocyanine green a ngiography and light microscopy of surgical specimen. Results: A thick yellow proteinaceous subretinal fluid was seen in the righ t macula of an 81-year-old white man. Fluorescein angiography indicated pro gressive leakage from undetermined source apart from a few focal hyperfluor escent points. Indocyanine green angiography showed several polyps as well as dilated choroidal vessels in the macula and along the superior temporal arcade. A large plaque was visualized in the late phase. Microscopically, t he specimen consisted of a thick fibrovascular membrane located on the chor oidal side of the retinal pigment epithelium (RPE), The RPE layer was disco ntinuous whereas on its choroidal side an almost intact layer of diffuse dr usen was observed. A group of dilated thin-walled vessels were found that a ppeared to be saccular on serial sections. Some of these were located almos t immediately under the diffuse drusen. Conclusion: Histologic examination of submacular tissue removed from an eye with polypoidal choroidal vasculopathy showed several aneurysmal dilatatio ns located directly under diffuse drusen within a sub-RPE, intra-Bruch's fi brovascular membrane.