For ophthalmology students

1. Dr. K. Vasantha M.S., F.R.C.S.
Director RIO Chennai (Rtd)

2.  More common in pigmented races
 Age – 60 to 70. Presents earlier than age related macular
degeneration
 Choroidal vessels are primarily involved with an
aneurysmal bulge, visible clinically as sub retinal reddish
orange polyp like structure

3.  Recurrent serous and hemorrhagic pigmentary epithelial
detachment due to leakage from the affected choroidal
vessels
 Compared to AMD vision may remain good as the lesion
is extra foveal
 Presents with defective vision, floaters, metamorphopsia
and central scotoma

4.  Reddish orange sub retinal raised lesions which are
more common in peripapillary area. May involve macula
also
 Serous or sero sanguinous PED
 Sub retinal hemorrhage
 Lipid deposits due to protein leakage from polyps
 Neuro sensory retinal detachment in the peripapillary or
macular retina

5.  The vascular abnormality may proliferate
 Polyp may become a vascular channel
 Cluster of vascular malformation can form a reddish
orange sub retinal mass
 Flattening of this mass
 RPE atrophy

6.  Quiescent – polyp present but no hemorrhage
 Active – exudates and hemorrhages present.
Peripheral exudative hemorrhagic chorio retinopathy
may break through and produce vitreous hemorrhage
also

7. ICGA EVEREST study:
 Nodular hyper fluorescence
 Hypo fluorescent halo around the nodule. As polyps leak
the halo will disappear
 Later the core will become hypo fluorescent
 Pulsation during dynamic ICGA
 Focal hyper fluorescence is an important sign.
 Stereo photography can be used to find the exact depth

8.  Abnormal irregular lattice network of blood vessels that
does not follow the lobular pattern
 Later hyper fluorescent isolated or cluster of polyps will
be seen
 Choroidal hyper permeability can be seen
 Late onset hyper fluorescence is due to staining of
unhealthy pigment epithelial cells or window defects
after 6 minutes
 After 10 minutes geographic hyper fluorescence with
demarcated margin and rosette pattern are seen

9.  Unless there is active leakage there will be a uniform
wash out of the dye
 Late ICG staining seen in classic or occult CNV is not
seen in idiopathic polypoidal choroidal vasculopathy

10.  This is done to differentiate sub retinal and intra retinal
fluid.
 Thumb like raised polyp with sharp peaked PED will be
seen
 Wavy elevated RPE with or without sharp notches
 Tall peaked PED
 Notch in the pigment epithelial detachment

11.  Hypo reflective lumen surrounded by hyper reflective
ring attached to the under surface of the PED
 Double layer sign- shallow irregular PED with elevation
of Bruch’s membrane
 In AMD choroid will be thin. Here it will be normal or even
thicker than normal

12.  Deep layer of vessels in the retina shows enlargement of
the foveal avascular zone, with loss of regular round
configuration
 Outer retina shows delicate neovascular structure
 Choroid may show defect in the vasculature due to polyp
base with finely branched new vessels at the edge of the
defect

13.  Central serous chorio retinopathy – younger age group
 Choroidal neovascularization – fibrous proliferation is
rare in PCV
 Choroidal hemangioma, osteoma
 Carcinoid metastasis

14. Serous detachment of RPE is seen in other conditions like
 CNV complicating CSR
 Dome shaped macula with sub foveal detachment in
myopia
 Pachy choroid neovasculopathy
 Optic disc pit
 Lupus erythematosus

15. Choroidal ischemia caused by
 Accelerated hyper tension
 Preeclampsia
 Systemic corticosteroid use
 Para proteinemia
 Choroidal tumors
 Vogt Koyanagi Harada disease
 Posterior scleritis

16.  AMD is seen more in whites, whereas PCV is seen in
pigmented races
 AMD is associated with soft drusen
 Local pigmentation is seen in AMD
 In AMD small caliber vessels are involved
 Greyish discoloration is often seen when CNV is present
 With ICG vessel wall staining is seen
 Choroid is thinner in age related macular degeneration
 Scar with fibrosis in AMD

17.  Standard fluence photo dynamic therapy (PDT) with or
without Ranibizumab or Ranibizumab alone
 PDT will cause thrombosis
 Polyps will resolve completely
 Thermal laser can be used for lesions beyond 100
microns from the fovea
 Photocoagulation to the leaking vessels with ICG
guidance has also been tried