Improved Visualization of Polypoidal Choroidal Vasculopathy Lesions Using Spectral-Domain Optical Coherence Tomography

In Brief Purpose: To report the tomographic features of vascular lesions beneath the retinal pigment epithelium in eyes with polypoidal choroidal vasculopathy by using spectral-domain optical coherence tomography (SD-OCT). Design: Retrospective observational case series. Methods: Angiograms and images obtained using the prototype SD-OCT system were compared for 21 eyes of 21 patients with polypoidal choroidal vasculopathy to identify sub-retinal pigment epithelium abnormalities visible on three-dimensional and enhanced SD-OCT images. Results: On angiography, a branching vascular network and at least 1 polypoidal lesion were visible in all 21 eyes; 10 eyes also had pigment epithelial detachment (PED). SD-OCT revealed a thin straight line of high reflectivity—Bruch’s membrane—associated with the branching vascular network in all 21 eyes, polypoidal lesions, 19 (90%) of the 21 eyes; and PED, 9 (90%) of the 10 eyes with PED. The vascular abnormalities of polypoidal choroidal vasculopathy (polypoidal lesion and branching vascular network) identified with angiograms were visualized on SD-OCT images in 20 of the 21 eyes (95%) as areas of moderate reflectivity between the clearly delineated abnormal section of retinal pigment epithelium and Bruch’s membrane. Conclusions: Enhanced SD-OCT imaging clearly depicted Bruch’s membrane beneath areas of abnormal retinal pigment epithelium in the same locations where the vascular abnormalities of polypoidal choroidal vasculopathy were evident on angiography. The authors showed that enhanced spectral-domain OCT (SD-OCT) provides improved visualization of sub-retinal pigment epithelium lesions in polypoidal choroidal vasculopathy, such as branching vascular networks and polypoidal lesions, and when tomographic images are compared with fluorescein/indocyanine green angiograms, these lesions can be visualized within Bruch’s membrane.