Noninvasive Vascular Imaging of Polypoidal Choroidal Vasculopathy by Doppler Optical Coherence Tomography

PURPOSE. To noninvasively investigate the vascular architecture of polypoidal lesions in polypoidal choroidal vasculopathy (PCV) using Doppler optical coherence tomography (OCT), and to evaluate the clinical usefulness of Doppler OCT for the assessment of therapeutic effects in PCV. METHODS. Fifteen eyes of 15 patients with treatment-naive PCV were prospectively studied. Vascular imaging was obtained using 1060-nm swept-source Doppler OCT, and compared with indocyanine green angiography (ICGA) images. The therapeutic effect of three consecutive intravitreal aflibercept injections was evaluated with ICGA and Doppler OCT. RESULTS. In Doppler OCT images, polypoidal lesions were clearly detected at the corresponding locations of lesions in the ICGA images. By being insensitive to dye leakage, Doppler OCT identified the complicated vascular structure in the polypoidal lesions. The identified mean area of the polypoidal lesions in the Doppler OCT images (0.04 mm(2)) was significantly smaller than that of the ICGA images (0.13 mm(2)). Polypoidal lesions were located in the retinal pigment epithelial detachment in 13 eyes, in the choroid in one eye, and in both the retinal pigment epithelial detachment and choroid in one eye. After intravitreal aflibercept treatment, areas of polypoidal lesions in the ICGA images were decreased in 14 of 15 eyes. This therapeutic effect was clearly confirmed in the Doppler OCT images. CONCLUSIONS. Doppler OCT imaging clearly detected fine vascular structures at the polypoidal lesions in PCV. Doppler OCT might be useful for the diagnosis and evaluation of therapeutic effects in PCV.