Polypoidal choroidal vasculopathy Polypoidal choroidal vasculopathy (PCV), initially called posterior uveal bleeding syndrome, is a variant of CNV (type 1) and presents with multiple, recurrent serosanguineous RPE detachments. A network of polyps is associated with feeder vessels that adhere to the RPE monolayer of the fibrovascular PED in a “string-of-pearls” configuration. Although PCV was first discovered in hypertensive middle-aged women of African American or Asian ancestry, it has since been identified in women and men of all races. In Asians, however, 20%–50% of cases of neovascular AMD are PCV type, whereas in whites the PCV type is responsible for <5% of cases of CNV. The associated serosanguineous detachments are often peripapillary and multifocal but may be peripheral, and there may be associated nodular, orange, subretinal lesions. Vitreous hemorrhage occurs more frequently in association with PCV than in non-PCV AMD. Soft drusen, typical in AMD, may or may not be present. A thickened or so-called pachychoroid is often present on EDI-OCT. Natural history and visual acuity outcomes of PCV may be better than those of CNV associated with AMD, except in cases with severe subretinal hemorrhage (Fig 4-13; see also Chapter 2, Fig 2-11 in this volume). ICG angiography, SD-OCT, and OCTA are useful for identifying the polyps. PCV is less responsive to anti-VEGF therapy than other types of CNV. The Everest Studies demonstrated that photodynamic therapy with verteporfin, with or without ranibizumab, results in better treatment response than ranibizumab alone.