PCV Treatment: Polypoidal Choroidal Vasculopathy

Polypoidal choroidal vasculopathy (PCV) is a form of wet age-related macular degeneration that can cause leakage and bleeding beneath the macula, the central part of the retina responsible for detailed vision. Eye injections that block vascular endothelial growth factor are an established first-line treatment. They can reduce fluid, control disease activity and improve or stabilise vision.

The condition is particularly relevant to Asian patients, in whom it accounts for a substantial proportion of wet macular degeneration. Recognising its characteristic features helps guide treatment and continued monitoring.

Changes beneath the macula

The retina is the light-sensitive tissue lining the back of the eye. Beneath it lies the retinal pigment epithelium, a supporting cell layer that helps maintain the health of the outer retina.

PCV involves a branching network of abnormal blood vessels beneath this supporting layer. Rounded enlargements within the network are called polypoidal lesions. Fluid or blood leaking from these vessels can disrupt the overlying macula and affect reading, recognition of faces and other detailed visual tasks.

Symptoms may include central blur, distorted straight lines or a dark patch near the centre of vision. Bleeding can cause a more sudden deterioration. The eye may appear normal externally despite significant changes at the back of the eye.

PCV in Asian patients

Clinical studies have reported polypoidal choroidal vasculopathy in approximately 25–50 per cent of Asian patients with wet age-related macular degeneration. This estimate concerns patients who already have wet macular degeneration, rather than the general Asian population. The proportion varies between studies and populations.

The condition also occurs in people of European and other ancestries. Ethnic background can inform the assessment, while the diagnosis depends on examination and retinal imaging.

Diagnosis and retinal imaging

Optical coherence tomography uses light to produce cross-sectional images of the retina. It can show fluid, elevations of the retinal pigment epithelium and other structural features that suggest the diagnosis. Repeated scans help assess disease activity and the response to treatment.

Indocyanine green angiography can identify the abnormal vascular network and polypoidal lesions more clearly. This involves a dye injected into a vein in the arm, followed by photographs of its passage through the eye’s circulation. It may be arranged when confirmation or further treatment planning is required.

Evidence for injection treatment

Vascular endothelial growth factor is a signalling protein involved in abnormal blood-vessel growth and leakage. Medicines that block its activity are delivered by an intravitreal injection into the vitreous cavity of the eye.

The 2025 Asia-Pacific Vitreo-retina Society consensus also recognises these injections alone as a first-line treatment option. The medication and injection schedule are selected according to the retinal findings and response. Outcomes vary between individuals.

Monitoring and ongoing treatment

Treatment response is assessed through vision testing, retinal examination and repeat imaging. Reduction in fluid and bleeding can be accompanied by improved vision even when some polypoidal lesions remain visible.

An initial course of injections is followed by an individualised treatment plan. Once the condition is controlled, the interval between injections may be extended gradually, with continued assessment at each visit. Returning fluid or bleeding may require shorter intervals, a change of medication or further investigation.

PCV can reactivate after an initial improvement. Continued review is therefore important even when vision feels stable. Established scarring or damage to the light-sensitive retinal cells may limit the extent of visual recovery.

Photodynamic therapy, which combines a light-sensitive medicine with targeted laser treatment, remains an option for selected cases. Referral for combination treatment can be considered where appropriate.

Assessment and treatment in Sydney

New central blur or distortion should be assessed promptly. Sudden substantial visual loss or a new dark central patch requires urgent same-day assessment.

Eye & Retina Specialists Sydney in Green Square/Waterloo provides retinal assessment, imaging and intravitreal injection treatment for polypoidal choroidal vasculopathy and other macular conditions. Treatment is tailored to the diagnosis, the health of the macula and the response over time.

Intravitreal injections carry risks. Individual outcomes vary, and the potential benefits, limitations and risks should be discussed with the treating ophthalmologist.