Polypoidal Choroidal Vasculopathy and Pachychoroid Neovasculopathy representing Different Manifestations of the Same Spectrum in the Same Patient: A Case Report

Abstract Background: The pachychoroid spectrum comprises various clinical manifestations. There are three exclusive characteristics, all of which have unknown etiology and controversial pathogenesis: a pachychoroid, the presence of pachyvessels at the external choroid and inner choroidal attenuation.Purpose: The purpose of this study was to describe a patient with clinical and multimodal manifestations in the pachychoroid spectrum.Patients: Here, we describe a single patient with an unusual disease presenting as different clinical variants in both eyes simultaneously. The patient presented with acute visual loss in the right eye with massive hemorrhagic maculopathy and a chronic decrease in visual acuity and metamorphopsia in the left eye with pigmentary changes and subretinal fluid at the geometric center of the fovea. Method: The patient underwent a complete ophthalmological examination and multimodal imaging and was diagnosed with polypoidal choroidal vasculopathy (PCV) and pachychoroid neovasculopathy (PNV), two different manifestations of the same disease spectrum occurring simultaneously.Results: Due to the active nature of the disease, the patient received three doses of intravitreal antiangiogenic agents in each eye.Conclusion: The diagnosis of CNV should always be considered when macular subretinal fluid is present. Although many different degenerative etiologies were considered, such as pathological choroidal neovascularization due to age-related macular degeneration (AMD) and the pachychoroid spectrum, the evaluation of the choroid vasculature through swept-source or enhanced depth imaging OCT revealed the disease origin to be idiopathic. PCV and PNV are considered to represent a single end stage of the pachychoroid spectrum with different manifestations; the former presents with aneurysmatic characteristics, while the latter lacks this anomaly.