Polypoidal Choroidal Vasculopathy (PCV)

Fundus photography and red-free image (right eye)

Retinal photos show pigmentary changes at the right macula, and the presence of hard exudates supero-temporal to the macula.

Optomap and fundus autoflourescence imaging (right eye)

FAF shows a ring-shaped area of hyper and hypo- autofluorescence at the macula.

Spectralis OCT line scans (right eye)

OCT shows a double layer sign, a peaked PED, and associated serous neurosensory detachment and intraretinal fluid. There is a sub-RPE ring-like lesion under the PED.

Spectralis OCT volume scan (right eye)

OCT shows a double layer sign, a peaked PED, and associated serous neurosensory detachment and intraretinal fluid. There is a sub-RPE ring-like lesion under the PED. These signs are suggestive of exudative PCV.

Cirrus OCT Angiography (right eye)

OCT angiography shows the presence of a tangled network of vessels consistent with type 1 choroidal neovascularisation.

Fundus photography and red-free image (right eye)

Fundus appearance shows a circinate ring of hyper reflective material, appearing exudative in nature, with dot like formations extending inferotemporally from the optic disc with an internal relatively red round area centrally. Depigmentation can also be seen at the macula centre as well as patches of altered pigmentation through the perimacula area.

Optomap widefield and fundus autofluorescence image (right eye)

Fundus appearance shows a circinate ring of hyper reflective material, appearing exudative in nature, with dot like formations extending inferotemporally from the optic disc with an internal relatively red round area centrally. Depigmentation can also be seen at the macula centre as well as patches of altered pigmentation through the perimacula area.

There are two areas of hypofluorescence with surrounding hyperfluorescence and a third area of mottled hyperfluorescence, all on the temporal side of the macula, which are suggestive of either previous or current sub retinal fluid episodes. There is a diffuse relative hypofluorescence extending inferotemporally from the optic nerve head with an internal more focal and distinct hypofluorescent centre. A larger area of mottled hypofluorescence is adjacent to this zone.

Spectralis OCT line scans (right macula)

OCT shows a shallow undulating RPE elevation through the macula area with underlying mixed reflectivity (1). A large round intraretinal lesion of mixed reflectivity can also be visualised (2). In addition, there is also atrophy of the outer retinal layers on the temporal macula. Inferior temporal to the disc (3) there is a large area of sub RPE hyporeflectivity causing marked elevation of the retina in this location and adjacent pockets of subretinal fluid as well as focal hyper reflectivities.

OCT Angiography (right macula)

OCT angiography shows a highly irregular network of vessels within the avascular slab centred on the macula.

Fundus photograph and red-free image (right eye)

Fundus photography shows a macular haemorrhage with surrounding hypo-pigmentary changes. Also noted are arterial attenuation and arteriovenous crossing changes.

Fundus autofluorescence (FAF) imaging

FAF imaging shows areas of hypo- autofluorescence corresponding to the macular haemorrhage due to blocking of the fluorescent signal. This was surrounded by an increase in autofluorescence.

Spectralis OCT line scans (right macula)

Top scan: OCT through the superior macula shows subretinal fluid.

Bottom scan: OCT through the fovea shows multiple, peaked pigment epithelial detachments (PED), a presence suggestive of type 1 macular neovascularisation. There was also subretinal fluid as well as subretinal hyperreflective material which may represent the haemorrhage or other exudative material. The underlying choroid showed dilation of the large choroidal vessels.

OCT Angiography

OCT angiography of the avascular complex shows the presence of a tangled network of vessels consistent with type 1 choroidal neovascularisation. In combination with the sharply peaked PEDs and macular haemorrrhages, a diagnosis of polypoidal choroidal vasculopathy is most likely.

Fundus photography and red-free image (left eye)

Retinal photos shows a well circumscribed orange nodule in the inferior macula of the left eye.

Optomap and fundus autofluorescence images

FAF reveals a mottled autofluorescent pattern at the macula.

Spectralis OCT line scans (left macula)

OCT images show a double layer sign and thumb-like PEDs.

Spectralis OCT volume scan (left macula)

OCT shows thumb-like PEDs and a double layer sign. There are no signs of exudation suggesting it is a quiescent lesion.

OCT Angiography (left macula)

OCT angiography shows tangled network of flow signal consistent with type 1 choroidal neovascular membrane. The flow signal colocalised with the thumb-like PED may correspond to the polypoidal lesion.

Colour fundus photograh and red-free image (right eye)

Retinal photos are unremarkable apart from some subtle hypopigmentary changes at the fovea.

Spectralis OCT line scans taken 5 years apart (right macula)

OCT comparison images show a significant change in the properties of the PEDs over time. In 2018, sharply-peaked PEDs with mixed internal reflectivity characteristic of PCV can be seen. By 2023, these have flattened and increased in length, forming FIPEDs. No sub-retinal fluid can be seen in the 2023 images.

Series of Spectralis OCT line scans taken in 2018 (right macula)

This series of OCT line scans show the sharply-peaked nature of the PEDs in PCV. Small amounts of sub-retinal fluid can be seen adjacent to the peaks.

OCT Angiography comparison (2018 and 2025 - rigth macula)

OCTA shows evidence of choroidal neovascularisation in 2018. By 2023 the appearance of the neovascular membrane has changed, becoming larger in area.