title: Polypoidal choroidal vasculopathy: natural history.
abstract: OBJECTIVE
  The present study was performed to clarify the long-term natural history of polypoidal choroidal vasculopathy (PCV).
  
  
  METHODS
  Prospective, consecutive observational case series.
  
  
  METHODS
  Fourteen eyes of 12 consecutive patients with PCV were prospectively followed in our clinic for at least 2 years without any treatment after a first visit to the clinic between February 1996 and November 1998. All patients underwent complete ophthalmologic examination, color fundus photography, and fluorescein and indocyanine green (ICG) angiography at regular intervals. Inclusion criteria were as follows: eyes had serous and/or hemorrhagic pigment epithelium detachment (PED) and retinal detachment in the posterior pole, and ICG angiography revealed a branching vascular network with polypoidal dilations at the terminals of the network. Exclusion criteria were as follows: other diseases such as exudative age-related macular degeneration, high myopia, angioid streaks, and presumed ocular histoplasmosis syndrome, and patients who previously underwent any ocular surgery.
  
  
  RESULTS
  Patients were followed for mean of 39.9 months (range, 24-54 months). PCV was present in 10 (83%) men and two women and in the elderly (mean age 68.1 years), usually unilateral (83%) with vascular lesions located at the macula (93%). The PCV manifested in two patterns, exudative and hemorrhagic. In the exudative pattern, serous PED and retinal detachment were predominant at the macula. The hemorrhagic pattern was characterized by hemorrhagic PED and subretinal hemorrhage at the macula. ICG angiography revealed polypoidal choroidal neovascularization that was changeable in appearance and repeatedly grew and spontaneously regressed, but the vascular network persisted. In some eyes, a collection of small aneurysmal dilations of vessels resembling a cluster of grapes appeared and all of them had marked bleeding and leakage and worse outcome.
  
  
  CONCLUSIONS
  Polypoidal choroidal vasculopathy is a long persistent chronic disease and the patients had a variable course. Fifty percent of the patients had a favorable course. In the remaining half of the patients, the disorder persisted for a long time with occasional repeated bleeding and leakage, resulting in macular degeneration and visual loss. Eyes with a cluster of grapes-like polypoidal dilatations of the vessels had a high risk for severe visual loss.
authors: Department of Ophthalmology, Kansai Medical University, Moriguchi, Osaka, Japan. uyamam@ceres.ocn.ne.jp
authors: Masanobu
authors: M
authors: Uyama
authors: Mitsumasa
authors: M
authors: Wada
authors: Yoshimi
authors: Y
authors: Nagai
authors: Takashi
authors: T
authors: Matsubara
authors: Hiroshi
authors: H
authors: Matsunaga
authors: Ichiro
authors: I
authors: Fukushima
authors: Kanji
authors: K
authors: Takahashi
authors: Miyo
authors: M
authors: Matsumura
mesh_terms: D000368:Aged; D002829:Choroid / Q000098:blood supply*; D015862:Choroid Diseases / Q000175:diagnosis* / Q000503:physiopathology; D004396:Coloring Agents; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D010781:Photography; D010857:Pigment Epithelium of Eye / Q000473:pathology; D011446:Prospective Studies; D012163:Retinal Detachment / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D012166:Retinal Hemorrhage / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D014792:Visual Acuity
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green