Polypoidal Choroidal Vasculopathy (PCV) is a condition that affects the vascular layer in the eye called the ‘Choroid’. This layer houses the blood vessels in the eye, and lies directly underneath the retina. When the structure of blood vessels in the choroid (choroidal vasculature) are studied closely under magnification, the condition is said to resemble a network of polyp-like growths. These abnormal growths result in damage to the cells responsible for receiving light that enters the eye, found in the retina right above the choroid. When these cells are damaged, the visual acuity of the patient is affected or compromised.
Patients with PCV present with sudden blurring of vision at the centre of their vision, due to a sudden bleeding from abnormal polypoidal vessels into the central retina or macula. Symptoms are often sudden without any prior telltale signs. In fact, eye doctors are often able to pick up abnormal polypoidal vessel growth beneath the retina on routine eye examinations, even before any symptoms. This is a good reason why patients should get their eyes checked regularly once a year to detect any early signs of this disease and prevent sudden vision loss.
Polypoidal choroidal vasculopathy (PCV) is a chronic eye disease affecting the choroidal blood vessels beneath the retina, leading to abnormal vascular formations called polypoidal lesions. The exact cause remains unclear, but it is believed to be multifactorial, involving genetic, environmental, and vascular factors.
PCV is strongly associated with dysfunction of the choroidal circulation, leading to abnormal branching of choroidal vessels and increased vascular permeability. Risk factors include age, genetic predisposition, and ethnicity, with a higher prevalence in Asian and African populations (Yannuzzi et al., 2010). Hypertension and smoking also contribute to vascular instability, potentially triggering PCV (Wong et al., 2019).
Inflammatory and oxidative stress mechanisms may play a role, leading to endothelial dysfunction and abnormal angiogenesis. The involvement of the vascular endothelial growth factor (VEGF) pathway suggests that PCV shares similarities with neovascular age-related macular degeneration (nAMD), though PCV responds differently to anti-VEGF therapy (Lafaut et al., 2000).
The initial and most crucial step in detecting Polypoidal Choroidal Vasculopathy (PCV) is undergoing a comprehensive eye examination with pupil dilation by an eye specialist. If further evaluation is needed, the specialist may recommend fluorescein angiography or indocyanine green angiography. These advanced imaging tests provide detailed visuals of the blood vessels in the affected area, aiding in the accurate identification of abnormalities and enhancing diagnostic precision.
Both fluorescein angiography and indocyanine green angiography involve injecting a specialized dye into a vein, typically in the arm or hand. Once the dye circulates through the bloodstream, retinal images are captured, allowing abnormalities to become more visible. This enhanced imaging helps the specialist assess vascular irregularities more effectively, leading to a more precise diagnosis.
The treatment approach for Polypoidal Choroidal Vasculopathy (PCV) shares similarities with that of Wet Age-Related Macular Degeneration (Wet AMD). In both conditions, an overproduction of Vascular Endothelial Growth Factor (VEGF) leads to leakage of blood and fluid from abnormal blood vessels. To control this leakage and prevent further damage, intravitreal injections of anti-VEGF medications are administered. Depending on the patient’s condition and severity, these injections may be required as frequently as every 4 to 6 weeks to stabilize the disease and reduce fluid accumulation.
Another treatment option for PCV is Photodynamic Therapy (PDT). This involves injecting a photosensitizing drug into the bloodstream, which makes the abnormal blood vessels in the eye more sensitive to light. A specialized cold laser is then applied to selectively target and destroy these abnormal blood vessels without harming the surrounding retinal tissue. PDT is often used in combination with anti-VEGF therapy for improved treatment outcomes, particularly in cases where anti-VEGF injections alone do not provide sufficient control of the disease.
A third-line treatment option, considered only when other methods are ineffective, is vitrectomy surgery. This procedure involves the removal of the vitreous gel from the eye and, if necessary, the extraction of accumulated fluid and blood caused by Polypoidal Choroidal Vasculopathy (PCV). Vitrectomy is typically reserved for severe cases where significant hemorrhaging or complications have occurred.
While PCV treatments share similarities with those for Wet Age-Related Macular Degeneration, we recognize that each patient’s condition is unique. A thorough assessment is essential to determine the most effective approach for preserving visual acuity and retinal health. Contact Asia Retina today to learn more about our personalized treatment plans tailored to your specific needs.
