Preferential Locations of Polypoidal Lesions and Adjacent Pigment Epithelium Detachments in Polypoidal Choroidal Vasculopathy in a Japanese Population.

Purpose: To analyze the relationship between neovascular lesions in polypoidal choroidal vasculopathy (PCV) and vortex vein characteristics.

Methods: Eighty eyes from 77 patients with PCV were examined using widefield swept-source optical coherence tomography (OCT) and indocyanine green angiography. Polypoidal lesions and pigment epithelial detachments (PEDs) were mapped onto choroidal en face OCT images. Vortex vein drainage areas were assessed for vertical asymmetry, and their associations with lesion locations were analyzed. Choroidal thickness was measured centrally and peripherally. Eyes were classified as pachychoroid or non-pachychoroid.

Results: Thirty-nine eyes (49%) and 41 eyes (51%) were included in the pachychoroid and non-pachychoroid groups, respectively. In total, 95 polypoidal lesions and 80 PEDs were identified. Significant clustering of polypoidal lesions and PEDs was observed near the upstream ends of the vortex veins (P < 0.001 for both), particularly in eyes with asymmetric vortex veins; however, no lesions were observed on the non-dominant side. Compared to the pachychoroid group, the non-pachychoroid group exhibited a higher number of soft drusen (P = 0.026) and lower central and peripheral choroidal thicknesses (P < 0.001 for both), along with less frequent Haller vessel dilation and choroidal vascular hyperpermeability (P < 0.001 for both).

Conclusions: The distribution of polypoidal lesions and PEDs in PCV eyes suggests that vortex vein abnormalities may contribute to its pathogenesis. Differences between pachychoroid and non-pachychoroid groups indicate distinct underlying pathologies. Assessing lesion locations relative to vortex veins may improve our understanding of PCV pathology and guide tailored treatments.