Skip to main content

  • Fundus photography, OCT show promise for detecting PCV

    Retina/Vitreous

    Add to My Bookmarks

    This study assessed the ability of 3 imaging methods to diagnose polypoidal choroidal vasculopathy (PCV) without indocyanine green angiography (ICGA).

    Study design

    Three retina specialists reviewed images of 124 eyes (120 patients) that presented with serosanguinous maculopathy in Thailand during a 4-year period. They assessed images of OCT, fluorescein angiography and fundus photographs. Two other retina specialists compared the same images along with ICG angiography, the current standard for visualizing PCV.

    Outcomes

    Specialists who assessed eyes with ICGA diagnosed 65 eyes with PCV, 45 eyes with central serous chorioretinopathy, and 12 eyes with more traditional neovascular AMD. A potential diagnostic feature seen on fundus photography was a notched or hemorrhagic pigment epithelial detachment. Using OCT, a retinal pigment epithelial detachment notch, a sharply peaked pigment epithelial detachment and a hyperreflective ring were potentially diagnostic. When at least 2 of these 4 signs were identified, the sensitivity, specificity and negative predictive value were all 95% and the positive predictive value was 92%.

    Limitations

    This was a retrospective study and the authors used ICGA as the gold standard. Clinicians who are looking for polypoidal on fundus photographs and OCT angiography may be more sensitive to these findings than practicing clinicians. The cohort was from Thailand and may not be representative of other groups. Finally, the study authors did not examine OCT angiography or swept-source OCT, which may have greater sensitivity for PCV.

    Clinical significance

    Polypoidal choroidal vasculopathy is a common manifestation of neovascular AMD and may constitute a significant percentage of patients diagnosed with exudative AMD in certain populations. Indocyanine green angiography is an invasive imaging modality that is not widely available, and some patients may be allergic to iodine. Having a widely available, low-cost, noninvasive method to detect PCV is important. Additional work will need to be done to validate these findings amongst a larger pool of patients from different backgrounds.