Choroidal Venous Architecture and Polypoidal Lesion Distribution in Subtypes of Polypoidal Choroidal Vasculopathy Using Widefield Imaging

Purpose: To investigate the spatial relationship between choroidal vortex veins (VVs), choroidal watershed zones (CWZs), and polypoidal lesion distribution in different subtypes of polypoidal choroidal vasculopathy (PCV) categorized by choroidal vascular hyperpermeability (CVH) status. Methods: This retrospective study analyzed 58 treatment-naïve PCV eyes using widefield imaging to map dominant VVs, CWZs, and lesion locations. Eyes were stratified into CVH (n = 32) and non-CVH (n = 26) groups. Comparative analyses were performed to evaluate the differences between PCV eyes and their unaffected fellow eyes, as well as between CVH and non-CVH eyes. Results: PCV eyes demonstrated significantly increased numbers of dominant VVs (P = 0.001) and temporal VV predominance (P = 0.039) compared to fellow eyes. Lesion distribution patterns differed significantly between CVH and non-CVH groups (P = 0.04). Although 71.8% of lesions (112/156) localized to dominant VV quadrants in both groups, CVH eyes showed greater CWZ involvement (23.9% vs. 10.3% in non-CVH; P = 0.029). Conclusions: The findings indicate that choroidal venous architecture and CVH-driven pathological changes may contribute synergistically to PCV pathogenesis, highlighting the interplay between anatomical vulnerability and pathological processes in PCV development. Translational Relevance: This study links choroidal VV distribution to PCV lesion localization, enabling risk-stratified imaging protocols. The CVH-specific CWZ involvement further guides personalized monitoring and hemodynamic-targeted adjuvant therapies.