Idiopathic polypoidal choroidal vasculopathy masquerading as choroidal tumors: one year follow-up of a peripheral lesion / Vasculopatia polipoidal idiopática da coroide simulando tumores da coroide: um ano de seguimento de uma lesão periférica

ABSTRACT This case report describes peripheral idiopathic polypoidal choroidal vasculopathy (IPCV) with a collection of small aneurysmal dilations that masqueraded as choroidal tumors in an elderly patient. A 68-year-old African American woman was referred to us with a suspected diagnosis of asymptomatic vascular choroidal tumor and choroidal capillary hemangioma, affecting the temporal peripheral fundus. Upon examination, optical coherence tomography (OCT) revealed two large hemorrhagic pigment epithelium detachments (PED), and indocyanine green angiography (ICG) confirmed the diagnosis of IPCV. One year later, there was reduction in the hemorrhagic pigment epithelium detachments and the lesion took on a different appearance, resembling a choroidal osteoma. No treatment was necessary despite the presence of multiple polyps. IPCV is a rare condition that can resemble other choroidal diseases depending on the stage of presentation. OCT is the best tool to determine the characteristics of the lesions, and indocyanine green angiography should be used to confirm the diagnosis. Not all cases require treatment.

RESUMO Relato de um caso de vasculopatia polipoidal idiopática da coroide (IPCV) com múltiplas dilatações aneurismáticas em região temporal periférica da retina, em uma paciente idosa que assemelhou-se com alguns tumores de coroide no seguimento de um ano. Paciente de 68 anos da raça negra, assintomática, foi encaminhada com a hipótese diagnóstica de um tumor vascular de coroide e hemangioma capilar da coroide, em região temporal inferior periférica da retina. Ao exame de tomografia de coerência óptica (OCT) era observado dois grande descolamentos de epitélio pigmentado (DEP), sendo confirmado o diagnóstico de vasculopatia polipoidal idiopática da coroide pela angiografia com indocianina verde (ICG). Após um ano, houve absorção do descolamento do epitélio pigmentado hemorrágico assemelhando-se assim ao osteoma de coroide. Nenhum tratamento foi necessário apesar da quantidade dos pólipos. A vasculopatia polipoidal idiopática da coroide é uma doença rara que, dependendo do estágio da apresentação, pode se assemelhar com algumas doenças da coroide. A tomografia de coerência óptica pode ilustrar melhor as características das lesões e a ICG confirma o diagnóstico. Nem todos os casos necessitam ser tratados.

Choroidal thickness measurement in healthy pediatric population using Cirrus HD optical coherence tomography / Medida da espessura da coroide na população pediátrica saudável usando tomografia de coerência óptica Cirrus HD

Purpose: To investigate the association between central choroidal thickness (CT), axial length (AL), age, gender, and refractive error in a healthy pediatric population using optical coherence tomography (OCT). Methods: This institutional study involved 137 healthy children (57 boys, 80 girls) aged between 4 and 18 years. Each child underwent a dilated eye examination, cycloplegic refraction, and AL measurement using a Nidek AL-Scan optical biometer. The central foveal thickness (CFT) and CT were measured using Cirrus high definition (HD)-OCT. The right eye of each subject was selected for analysis. Results: The mean age of the children was 10.0 ± 4.7 years (range, 4-18 years). The mean spherical equivalent (SE) was -0.24 ± 1.24 diopters (D) (range, -2.00 D to +2.25 D). The mean AL was 23.1 ± 1.2 mm (range, 20-27 mm). The mean central CT was 388.2 ± 50.0 μm and was not correlated with age, gender, AL, or refractive error. Conclusion: The data provide a pediatric normative database of CT using enhanced depth imaging OCT. This information may be useful in the diagnosis and monitoring of retino-choroidal diseases in children. .

Objetivo: Investigar a associação entre a espessura central da coroide e o comprimento axial (AL), idade, sexo e erros de refração em uma população pediátrica saudável por meio da tomografia de coerência óptica (OCT). Métodos: Estudo institucional envolvendo 137 crianças saudáveis (57 meninos, 80 meninas), com idades entre 4 e 18 anos. Cada criança foi submetida a um exame de fundo de olho, refração sob cicloplegia e medida do comprimento axial usando o biométrico óptico Nidek AL-Scan (Nidek CO, LTD.). A espessura foveal central (CFT) e espessura da coroide (CT) foram medidas utilizando o Cirrus HD-OCT (Carl Zeiss Meditec). O olho direito de cada sujeito foi selecionado para análise. Resultados: A idade média das crianças foi de 10,0 ± 4,7 anos (variação, 4 a 18 anos). O equivalente esférico médio (SE) foi -0,24 ± 1,24 dioptrias (D) (variação de -2,00 D a +2,25 D). A média do comprimento axial foi de 23,1 ± 1,2 mm (variação, 20 a 27 mm). A espessura da coroide central média foi de 388,2 ± 50,0 mm e não se correlacionou com a idade, sexo, comprimento axial ou erro refrativo. Conclusão: Os resultados proporcionam uma base de dados pediátrica normativa da espessura da coroide usando tomografia de coerência óptica com profundidade de imagem aprimorada. Esta informação pode ser útil no diagnóstico e acompanhamento de doenças de retina e coroide em crianças. .

Histopathology observation of hemorrhagic age-related macular degeneration / 中华眼底病杂志

Ovjective To observe the surgically excised specimens from eyes with hemorrhagic agerelated macular degeneration (AMD).Methods Thirty-six surgically excised specimens were captured from 36 patients with hemorrhagic AMD,26 specimens were diagnosed as occult choroidal neovascular membrane (CNVM),10 specimens were diagnosed as polypoidal choroidal vasculopathy (PCV).All specimens were routinely processed by hematoxylin and eosin,periodic acid-Schiff's stain and Masson stainings.At the maximum horizontal and vertical slice of the specimens,the category and amount of the cells in the specimen were recorded,as well as the relationship between the specimens and the surrounding tissue.Results The 36 specimens are categorized as neovascular membrane dominant (19/36),collagen fiber dominant (6/36),blood clot dominant (8/36) and degenerated thickened Bruch's membrane dominant (3/36).Eighteen occult CNVM specimens and 1 PCV specimen are categorized as neovascular membrane dominant; all 6 collagen fiber dominant specimens are occult CNVM; 1 occult CNVM and 7 PCV specimens are categorized as blood clot dominant; and 1 occult CNVM and 2 PCV specimens are categorized as degenerated thickened Bruch's membrane dominant.The occult CNVM categorized as neovascular membrane dominant present as small blood vessel with single endothelium cell attached; the PCV specimen categorized as neovascular dominant presents as big blood vessel with thick vessel wall under the Bruch's membrane,retinal pigment epithelium and choroidal melanocyte are both observed in the PCV specimens.Conclusion The components of the specimens captured from eyes with hemorrhagic AMD are diversified.

The differences and similarities between polypoidal choroidal vasculopathy and age related macular degeneration is worthy for further investigation / 中华眼底病杂志

Polypoidal choroidal vasculopathy (PCV) is one of the exudative maculopathy,which is characterized by retinal pigment epithelium detachment,subretinal hemorrhages and sensory retinal detachment.The prevalence of polypoidal choroidal vasculopathy (PCV) reached 33.5％ in neovascular age related macular degeneration (AMD) for Chinese population.Indocyanine green angiography showed a single or multiple focal nodular areas of hyperfluorescence arising from the choroidal circulation and currently is recognized a gold standard for diagnosis of PCV.The histopathologic findings indicated that hyalinization of choroidal vessels,like arteriosclerosis.Up to now there is no reliable evidence to demonstrate the difference in genetic study.The study of environment factor showed hypertension is associated with PCV closely than with AMD.PCV and AMD is different genotype or different phenotype as well as difference in pathogenesis need further studies.