Idiopathic Polypoidal Choroidal Vasculopathy Appearance Under Aflibercept Treatment

A 61-year-old man presented with distorted vision and metamorphopsia in the right eye (RE) for 1 month. The corrected distance visual acuity (CDVA) was 6/9 in the RE and 6/6 in the left eye. Fundus of the RE revealed a large pigment epithelial detachment (PED) in the foveal region with a suspected rim of shallow subretinal fluid (SRF) along with multiple surrounding soft drusens, confirmed on optical coherence tomography and fluorescein angiography. Indocyanine green angiography (ICGA) showed a corresponding hypocyanescent area in the macula indicative of PED with no evidence of a hot spot or branching vascular network. The patient was advised and injected with intravitreal aflibercept in the RE over 6 months. The CDVA remained stable with the waxing and waning height of the PED. After 7 months, the patient developed subretinal exudates along with PED and increased SRF in the RE. ICGA was repeated, and a bunch of grape-like hypercyanescent hot spots was noted at the nasal border of the PED. A diagnosis of idiopathic polypoidal choroidal vasculopathy (IPCV) along with central serous chorioretinopathy (CSCR) was established. This case raises the possibility that vascular endothelial growth factor may barely contribute to the development of IPCV. Also, the present case may provide evidence that IPCV with CSCR forms a part of the pachychoroid spectrum.