title: The natural history of polypoidal choroidal vasculopathy: a multi-center series of untreated Asian patients.
abstract: OBJECTIVE
  We aimed to evaluate the long-term natural history of polypoidal choroidal vasculopathy (PCV) in untreated patients.
  
  
  METHODS
  This is a retrospective observational case series. Patients with symptomatic PCV who did not receive any treatment for at least 12 months were included from the records of three ophthalmic clinics in Asia. The medical records and imaging data were reviewed. Visual outcomes at month 12 and at last follow-up were analyzed. The influence of demographics and presenting features on visual outcome was analyzed.
  
  
  RESULTS
  A total of 32 eyes (32 patients) were included in this analysis. The mean follow-up was 59.9 months (range, 18-119 months), the mean age was 65.7 years and 21 (65.6 %) patients were male. The mean presenting logMAR visual acuity was 0.79 (Standard deviation [SD] 0.49). The center of the fovea was involved by the PCV complex in 25 eyes (78.1 %). The mean greatest linear dimension (GLD) of the PCV complex was 2584 μm (SD 880). Twenty-three eyes (71.9 %) had a cluster-of-grapes configuration on indocyanine green angiography. Leakage of fluorescein angiography was present in 29 eyes (90.6 %). The mean logMAR vision deteriorated from 0.79 at baseline to 0.88 at month 12 (p = 0.11), and further to 1.14 (p = 0.003) at the last follow-up. The proportion of eyes that improved, remained unchanged and worsened was 21.9 %, 31.3 % and 46.9 %, respectively, at month 12; and 28.1 %, 9.4 % and 62.5 %, respectively, at last follow-up. The proportion of eyes with logMAR vision worse than 1.0 was 28.1 % at presentation, and increased to 31.3 % at month 12 and further to 53.1 % at last follow-up. Reasons for poor vision were due to retinal, subretinal or vitreous hemorrhage, and retinal pigment epithelium (RPE) atrophy and scarring. None of the presenting features were found to significantly influence visual outcome.
  
  
  CONCLUSIONS
  Half of eyes presenting with symptomatic PCV had a relatively benign course without treatment and some even had vision improvement. However, in the remaining eyes, vision deteriorated significantly, mainly due to hemorrhage and scarring. There may be subtypes of PCV with divergent natural history.
authors.affiliation: Medical Retina Service, Singapore National Eye Centre, Singapore, Singapore. gemmy.cheung.c.m@snec.com.sg.|Eye Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore, Singapore. gemmy.cheung.c.m@snec.com.sg.|Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore. gemmy.cheung.c.m@snec.com.sg.|Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. gemmy.cheung.c.m@snec.com.sg.
authors.forename: Chui Ming Gemmy
authors.initials: CM
authors.lastname: Cheung
authors.affiliation: Medical school, University of Oxford, Oxford, United Kingdom.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Yang
authors.affiliation: Department of Ophthalmology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Won Ki
authors.initials: WK
authors.lastname: Lee
authors.affiliation: Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Gary K Y
authors.initials: GK
authors.lastname: Lee
authors.affiliation: Medical Retina Service, Singapore National Eye Centre, Singapore, Singapore.|Eye Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore, Singapore.
authors.forename: Ranjana
authors.initials: R
authors.lastname: Mathur
authors.affiliation: Medical Retina Service, Singapore National Eye Centre, Singapore, Singapore.
authors.forename: Jacob
authors.initials: J
authors.lastname: Cheng
authors.affiliation: Medical Retina Service, Singapore National Eye Centre, Singapore, Singapore.|Eye Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore, Singapore.
authors.forename: Doric
authors.initials: D
authors.lastname: Wong
authors.affiliation: Medical Retina Service, Singapore National Eye Centre, Singapore, Singapore.|Eye Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore, Singapore.|Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.|Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Tien Yin
authors.initials: TY
authors.lastname: Wong
authors.affiliation: Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Timothy Y Y
authors.initials: TY
authors.lastname: Lai
mesh_terms: D000368:Aged; D044466:Asian People / Q000208:ethnology; D020256:Choroidal Neovascularization / Q000175:diagnosis* / Q000208:ethnology / Q000503:physiopathology; D004396:Coloring Agents / Q000008:administration & dosage; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011127:Polyps / Q000175:diagnosis* / Q000208:ethnology / Q000503:physiopathology; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: Natural history; Observation; Polypoidal choroidal vasculopathy; Untreated; Visual outcome