Polypoidal Choroidal Vasculopathy (PCV)

Polypoidal choroidal vasculopathy (PCV) is a disease primarily affecting the vascular layer of blood vessels in the choroid, resulting in damage to the overlying retina where the photoreceptor cells responsible for vision reside. The abnormal vessels in PCV are unique in their appearance because they appear as orange bulges, or resemble a ‘bunch of grapes’ and sometimes a ‘string of pearls’.

Who are at risk of PCV?

• Tends to occur in individuals over the age of 60 (but may occur much younger)
• Affects those of Asian and African descent more than Caucasians
• History of cigarette smoking
• Hypertension
• Family history

Yes, it is considered one of the subtypes of wet AMD (the others being CNV (choroidal neovascularisation) and RAP (retinal angiomatous proliferation). It shares clinical features with typical wet AMD in that abnormal vessels leak fluid or blood into or under the retina. Without treatment, they may cause scarring or thinning (sometimes called atrophy) of retinal tissue.

Patients with PCV often experience blurred vision or a blind spot in (or near) the centre of their vision in one or both eyes. Occasionally, it may cause sudden severe loss of vision due to massive bleeding in the eye.

The most important test used to diagnose PCV is a careful dilated eye examination by your ophthalmologist. In addition, fluorescein and indocyanine green (ICG) angiography may be useful. These 2 tests are able to create detailed images of the retinal and choroidal blood vessels, which can assist your ophthalmologist in identifying important abnormalities. Both tests require a special dye to be injected into a vein (usually in the arm or hand) before retinal photographs are taken. 

Optical coherence tomography (OCT) scanning of the retina is also routinely used to aid in diagnosis of PCV.

The most common treatments for PCV are intravitreal injections of an anti-VEGF medication and photodynamic therapy (PDT).

Successful treatment of PVC often requires repeat dosing of anti-VEGF medication as frequently as every 4-6 weeks to prevent increased leakage or bleeding. In photodynamic therapy (PDT), an intravenous infusion of a special photosensitizing medication (verteporfin) is injected over 10 minutes; this makes the eye more sensitive to light. Then a cold laser is applied to the retina and choroid to damage or destroy the abnormal blood vessels found in PCV.

On rare occasions, surgical vitrectomy (a procedure to remove the eye’s vitreous gel) may be used to remove or displace a large haemorrhage caused by PCV.

The response to treatment is good with about 90% of treated patients avoiding severe vision loss. About one third of patients do very well with significant improvement of vision after treatment. Initially, the disease may wax and wane even without treatment but ultimately, most patients go on to develop irreversible scarring and loss of central vision.