Polypoidal Choroidal Vasculopathy in Congolese Patients

Abstract

Purpose: Polypoidal choroidal vasculopathy (PCV) is a visually debilitating disease that mostly affects people of African and Asian heritage. Indocyanine green angiography (ICGA) is the recommended exploratory method for definitive diagnosis. The disease has been extensively described in Asians and Caucasians, but not in Africans. This study was conducted to document the clinical presentation and optical coherence tomography features of polypoidal choroidal vasculopathy (PCV) in Congolese patients.

Methods: A prospective case series of patients with PCV was performed between January 2017 and June 2019. Routine ocular examination was performed including best corrected visual acuity measurement, slit-lamp examination, dilated direct fundoscopy, and spectral domain optical coherence tomography (OCT). The diagnosis was based on a combination of clinical and OCT signs.

Results: Fourteen patients were diagnosed with PCV during this period. The average age was 64.7 ± 6.9 years. There were 8 females. Ten (71.4%) patients had systemic hypertension. Most patients (n = 9, 64.3%) had bilateral involvement. Blurred vision was the most common complaint (71.4%). The main clinical presentation was subretinal exudates, seen in 19 (82.6%) eyes of 11 (78.6%) patients and subretinal hemorrhage in 10 (43.5%) eyes. Macular localization was found in 16 eyes (69.5%) of 12 (85.7%) patients. Drusen were observed in 35.7% of the patients. On OCT imaging, thumb-like pigment epithelial detachment and subretinal exudation were the most frequent features, observed in 92.9% and 71.4% of the patients, respectively.

Conclusions: PCV in Congolese patients showed features that are more similar to those observed in Caucasians. In this setting where indocyanine green angiography is not available, OCT facilitates the diagnosis of PCV.

Figure 1

Fundus photos and OCT scans for a patient with bilateral PCV. (a) Fundus photo of the right eye which displays temporal subretinal hemorrhage with central subretinal fluid. (b) OCT shows multiple pigment epithelial detachments (asterix). (c) Fundus photo of the left eye displays a red-orange nodule in the superior macula and multiple areas of subretinal hemorrhage within the temporal macula and extending to the arcades. (d) Corresponding OCT image shows a temporal branching vascular network (arrow), with subretinal hyperreflectivity, serosanguineous pigment epithelial detachment (asterix), and subretinal fluid (triangle).

Figure 2

Imaging of a patient with bilateral PCV. (a) Fundus photo of the right eye shows red-orange nodules within the superior macula with hard exudates and resolving subretinal hemorrhage. (b) Corresponding OCT shows subretinal fluid with branching vascular network (arrow) with classic double layer sign. (c) Fundus photo of the left eye shows subretinal hemorrhage with resolving hemorrhage superior to the optic nerve. (d) OCT displays a large pigment epithelial detachment (asterix) which is characteristic finding in patients with PCV.

Figure 3

(a) Fundus photo of the left eye in a patient with unilateral PCV displaying exudates, subretinal hemorrhage, and a pigment epithelial detachment. (b) OCT shows subretinal fluid with subretinal hyperreflectivity (triangle), a pigment epithelial detachment (asterix) with a thumb-like projection and notch which is characteristic of a polyp lesion. (c) Fundus photo of the right eye. (d) OCT shows pigment epithelial detachment (asterix) and adjacent retinal atrophy.

Figure 4

(a) Fundus photo of the right eye in another patient with unilateral PCV showing red-orange nodules and in the posterior pole and subretinal fluid and a pigment epithelial detachment. (b) OCT shows few subretinal fluid (triangle), multiple pigment epithelial detachments (asterix) and notched thumb-like elevation, and branch vascular network (arrow).