Pulsatile Blood Flow in the Polypoidal Choroidal Vasculopathy

Objective To describe patients with pulsatile polypoidal vessels in polypoidal choroidal vasculopathy (PCV). Design Retrospective, observational case series. Participants Eighty-four eyes of 74 patients with PCV. Methods The medical records of patients diagnosed with PCV between 1998 and 2004 at Kagoshima University Hospital were reviewed. Main Outcome Measures A pulsatile polypoidal vessel (PV) on indocyanine green angiography (ICGA). Results Seven of 74 patients (9.5%) had PVs in the macula. Four eyes revealed pulsatile PVs on the day the diagnosis of PCV was first made, and PVs in the other 3 eyes showed pulsatile movement during the follow-up period. Two patterns of pulsatile movement were observed on ICGA: (1) a rhythmic variation in the caliber of a choroidal vessel (caliber variation pattern) and (2) a pulsatile blood flow in a tortuous and relatively narrow choroidal vessel (pulsatile blood flow pattern). Both patterns of pulsatile PVs appeared in the early frames of the ICGA, and some of them were observable even during the first 15 minutes after the ICG dye injection. The pulsatile movement disappeared spontaneously without treatment in some patients, and the period in which pulsatile PVs was detectable on ICGA was limited in each patient. Conclusions We report the features of pulsatile PV in PCV. It is a unique and important characteristic that has not been reported with any other chorioretinal diseases and may provide a clue to understanding the pathogenesis of PCV.