Suraj Eye Institute · Medical Retina
Polypoidal Choroidal Vasculopathy (PCV)
EN: A common but often-missed cause of wet macular disease in Indian patientsहिंदी: पॉलिपॉइडल कोरॉइडल वैस्कुलोपैथीमराठी: पॉलिपॉइडल कोरॉइडल व्हॅस्क्युलोपॅथी
Polypoidal Choroidal Vasculopathy (PCV)
Polypoidal Choroidal Vasculopathy, or PCV, is a disease of the choroidal blood vessels — the layer of vessels behind the retina. Abnormal branching vessels develop polyp-like dilations that leak fluid or bleed under the retina, damaging central vision. PCV is often mistaken for wet age-related macular degeneration (AMD), but it behaves differently, requires different imaging to confirm, and is treated somewhat differently.
PCV is especially relevant for Indian patients. Up to one in three patients diagnosed as “wet AMD” in Asian populations actually has PCV. It tends to occur about a decade earlier than typical AMD and can present with sudden, dramatic bleeding.
What Happens Inside the Eye
The retina is nourished from behind by a thick layer of blood vessels called the choroid. In PCV, an abnormal branching network of vessels develops within the inner choroid, and at the tips of these branches, small bulbous dilations form — the “polyps”. These polyps are fragile. They leak fluid or break open and bleed, causing sudden distortion or loss of central vision.
In PCV an abnormal branching vascular network grows inside the choroid and develops bulbous polyps at the tips. These polyps leak and bleed, lifting the retinal pigment epithelium and pushing fluid and blood under the retina.
Symptoms
- Sudden drop in central vision (especially after a bleed)
- Distorted or wavy lines (metamorphopsia)
- A dark patch in the centre of vision
- Often one eye first; the second eye is at increased risk later
- Vision may seem normal on the side, but reading and faces become difficult
Who Is at Risk?
- Age 50–65 (younger than typical AMD)
- Male gender (more often than female in Asian populations)
- Hypertension
- Smoking
- Asian / Indian ethnicity
- Sometimes a family history of macular disease
How PCV Differs from Typical Wet AMD
| Feature | PCV | Typical Wet AMD |
|---|---|---|
| Age of onset | 50–65 | 65+ |
| Sex | More common in men | Roughly equal |
| Drusen | Usually absent | Present |
| Submacular bleed | Often large and dramatic | Less common, smaller |
| OCT finding | Sharp peaked PED, “double-layer sign” | Type 1 / 2 CNV |
| Confirmatory test | ICG Angiography shows polyps | FA shows classic CNV |
| Best treatment | Anti-VEGF ± PDT (combination often needed) | Anti-VEGF monotherapy |
How We Diagnose PCV
- Dilated retinal examination — sub-RPE nodules can sometimes be seen as orange-red bumps
- OCT — sharp peaked retinal pigment epithelium detachment (PED), “double-layer sign”, subretinal fluid, sometimes a notch in the PED
- Indocyanine Green Angiography (ICGA) — the gold standard. Bright “hot-spots” mark the polyps, surrounded by a branching vascular network
- OCT-Angiography — non-invasively shows the branching vascular network
- Fluorescein angiography — to assess leakage and rule out classic CNV
- Fundus autofluorescence — supportive in selected cases
If you have been told you have “wet AMD” but treatment is not working well, ask whether ICG Angiography has been done. Missed PCV is one of the most common reasons wet macular disease fails to improve.
Treatment Options
- Intravitreal anti-VEGF injections — Aflibercept, Faricimab, Ranibizumab, Brolucizumab and Bevacizumab are all used. Most patients receive 3 monthly loading doses, then individualised maintenance.
- Photodynamic Therapy (PDT) — verteporfin is given by drip, then a special low-power laser is applied to the polyps. PDT is particularly effective at closing polyps in PCV.
- Combination therapy — anti-VEGF + PDT, often the best approach for large or resistant polyps.
- Observation — for asymptomatic, extrafoveal polyps that are not threatening vision.
- Submacular surgery — rarely, for massive submacular haemorrhage that does not clear with injections.
What to Expect from Treatment
- Stabilisation is the primary goal. Vision improvement is possible but less predictable than in pure wet AMD.
- Long-term follow-up is essential — recurrences are common, sometimes years later.
- The other eye must be monitored regularly — PCV often develops in the second eye over time.
- Bleeding episodes may recur. Catching them quickly limits damage.
Living with PCV
- Amsler grid daily for both eyes
- Strict blood pressure control
- Complete smoking cessation
- Sun protection (sunglasses outdoors)
- AREDS2 supplements if there are coexisting drusen
- Inform any doctor before starting new medication that may raise blood pressure or thin the blood
When to Come to Us Immediately
Sudden blurring, a new dark spot, or sudden distortion in either eye — these may signal a fresh bleed needing urgent attention. Come the same day.
In short: PCV is a common cause of sudden central vision loss in Indian patients — often mistaken for wet AMD. With ICGA-based diagnosis and modern combination treatment, most patients keep useful vision.
Frequently Asked Questions
I was told I have wet AMD — could it actually be PCV?
Possibly. If your treatment has not been working well, or if you are male and under 65, ICG Angiography should be done to look specifically for polyps. The treatment plan may need to change.
Will PDT damage my retina?
Modern PDT uses a reduced laser fluence and is highly targeted to the polyps. Some swelling may occur in the first few days. The benefit of closing the polyps generally outweighs the small risk of laser-related damage.
Why do I sometimes need both anti-VEGF and PDT?
Anti-VEGF controls leakage and bleeding; PDT shrinks and closes the polyps themselves. In many patients the combination gives the best long-term result.
My other eye is normal — what is its risk?
Over years, about a third of PCV patients develop disease in the second eye. We monitor the good eye carefully and ask you to check daily with the Amsler grid.
Can PCV come back after treatment?
Yes — recurrences are common, sometimes after years of stability. Long-term follow-up and prompt action at first sign of recurrence are essential.
Is PCV inherited?
There is a genetic component (variations in genes such as CFH and ARMS2), but most patients have no clear family history. Lifestyle factors — blood pressure and smoking — are at least as important.
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