Bulbosities and Intervortex Venous Anastomosis in Venous Overload Choroidopathy Masquerading as Polypoidal Choroidal Vasculopathy.

To describe a patient with venous overload choroidopathy in whom venous bulbosities masqueraded as polyps and intervortex venous anastomosis mimicked a branching vascular network, giving the appearance of polypoidal choroidal vasculopathy (PCV). The patient had complete ophthalmic examination including indocyanine green angiography (ICGA) and optical coherence tomography (OCT). Venous bulbosities were defined on ICGA as focal dilations in which the diameter of the dilation is 2 times that of the host vessel. A 75-year-old female presented with combined subretinal and sub-retinal pigment epithelium (RPE) hemorrhages in the right eye. During ICGA, focal nodular hyperfluorescent lesions connected to a network of vessels were observed, which looked like polyps and branching vascular network in PCV. In both eyes, the mid-phase angiogram had multifocal choroidal vascular hyperpermeability. There was late-phase placoid staining nasal to the nerve in the right eye. During EDI-OCT evaluation, there were no RPE elevations that would be expected with polyps or branching vascular network in the right eye. A double layer sign was seen corresponding to the placoid area of staining. Diagnosis of venous overload choroidopathy and choroidal neovascularization membrane was made. She was treated with intravitreal anti-vascular endothelial growth factor injections for the choroidal neovascularization membrane. ICGA findings in venous overload choroidopathy may mimic PCV, but differentiation is essential as it has implications for treatment. Similar findings may have been misinterpreted in the past and may have previously contributed to conflicting clinical and histopathologic descriptions of PCV.