Polypoidal Lesions Associated with Choroidal Nevi

Purpose: To investigate eyes with polypoidal lesions associated with choroidal nevi, their multimodal imaging characteristics, and long clinical follow-up. Methods: Multicenter, retrospective case series study of patients with polypoidal lesions overlying choroidal nevi. Demographic and clinical information was recorded. Multimodal imaging including colour fundus photography (CFP), optical coherence tomography (OCT), OCT angiography, fundus fluorescein angiography (FA), indocyanine angiography (ICGA) and A- and B-scan ultrasonography were analyzed for nevus and polypoidal lesion characteristics. Results: Fourteen eyes (14 patients; mean age: 70.3±6.7 years) with polypoidal lesions overlying choroidal nevi were included. The mean follow-up duration was 50.0±27.9 months (range 12-108). All nevi were pigmented on CFP, flat on ultrasonography with a mean basal diameter of 3.8±0.4 mm. In all but one eye, OCT showed a shallow irregular pigment epithelium detachment (SIRE) overlying the nevus. A total of 11/14 eyes (78.6%) had exudative activity, 9 eyes received intravitreal anti-vascular endothelial growth factor (VEGF) injections, and one eye required intravitreal anti-VEGF combined with photodynamic therapy (PDT). Mean visual acuity was 20/32 at baseline and 20/50 at final visit. Conclusions: We present the largest known cohort of eyes with polypoidal lesions associated with choroidal nevi with up to 9 years follow-up. The exudative degree of the polypoidal lesion in this condition is variable and treatment decisions should be taken on an individual basis. We hypothesize that choroidal ischemia due to altered choroidal vasculature rather than Haller layer hyperpermeability plays a role in the formation of polypoidal lesions overlying nevi.