Choroidal Venous Pulsations at an Arterio-venous Crossing in Polypoidal Choroidal Vasculopathy

It has been reported that pulsations in abnormal vessels are observed on indocyanine green (ICG) angiography in half of patients with polypoidal choroidal vasculopathy (PCV), although the mechanism of the pulsation is unknown. In this study, we report a case of PCV showing venous pulsations at an arterio-venous (A-V) crossing, and discuss a possible mechanism of polypoidal vessel formation and pulsations in PCV. A 66-year-old female presented with a reddish-orange elevated lesion and serous retinal detachment in the macula of her left eye, and was diagnosed as PCV. She was treated with photodynamic therapy (PDT), and followed-up through routine examinations, including ICG angiography. ICG angiography at presentation showed a branching vascular network and choroidal venules with dye leakage (polypoidal vessels) in the left eye. Pulsations, supposedly of venous origin, were observed at an A-V crossing in the abnormal vessels. Within 3 months after PDT, the polypoidal vessel ceased to leak and the pulsations vanished. The reddish-orange lesion gradually decreased in size with complete disappearance of retinal detachment. This study suggests that an unusual compression at an A-V crossing may make a venule polypoidal, and fluctuations of blood flow and pressure in the venule may cause pulsatile movements of the vessel wall.

Mechanism and clinical application of spontaneous retinal venous pulsations / 中华实验眼科杂志

Spontaneous retinal venous pulsations(SVPs) appears in 90％ of normal persons.It is seen as a rhythmic subtle narrow and expansion of one or more retinal veins on the optic disc.Many researches have demonstrated that SVPs could be applied to the intracranial pressure(ICP) monitoring as well as diagnoses and fellow up of glaucoma.But there is no corresponding domestic research in this field up to now.Although the physiological mechanism of the venous pulsations has been the point of much debate,its potential clinical value attract our attention.The present paper reviewed the progress in current understanding of the mechanism behind the SVPs,the examination method and application of SVPs in clinical study.