Polypoidal choroidal vasculopathy and late geographic hyperfluorescence on indocyanine green angiography

Background/aims: To report the clinical significance of late geographic hyperfluorescence (LGH) on indocyanine green angiography (ICGA) in cases of polypoidal choroidal vasculopathy (PCV). Methods: The medical records of 43 eyes with PCV, all of which had undergone at least 12 months of follow-up, 40 eyes with exudative age-related macular degeneration (AMD) and 20 eyes of age-matched normal subjects were retrospectively analysed. The incidence of LGH, defined as a well-demarcated geographic hyperfluorescent lesion on late phase ICGA, was compared in each respective group. The natural course of the LGH and its changes after photodynamic therapy (PDT) were analysed. Results: LGH was noted in all of the eyes with PCV, whereas LGH was noted in three eyes (7.5%) of the eyes with exudative AMD and was not noted in any of the normal subjects (p<0.01). Of the 27 eyes (62.8%) with PCV, LGH was matched to the total area of the branching vascular network and polyps. The extent of LGH was enlarged over time in approximately one-half of the cases. As compared with the eyes demonstrating persistent LGH after PDT, the eyes with fading or disappearing LGH evidenced a lower recurrence of active PCV (p<0.05). Conclusion: LGH is a highly sensitive and specific ICGA finding for the diagnosis of PCV. Increased surveillance should be implemented in eyes in which LGH persists after PDT.