Background:<br> Polypoidal choroidal vasculopathy (PCV) is a subtype of macular neovascular disease characterized by aneurysmal polypoidal dilations arising from abnormal choroidal vascular networks. It is often associated with age-related macular degeneration and may lead to progressive visual impairment. Case presentation:<br> We report the case of a 75-year-old female patient with a history of systemic hypertension for 10 years who presented with progressive visual acuity decline evolving for approximately one year. Fundus examination revealed an abnormal macular reflex. Optical coherence tomography (OCT) showed a large pigment epithelial detachment associated with macular thickening. Fluorescein angiography demonstrated progressive hyperfluorescence with late leakage consistent with choroidal neovascularization. Conclusion:<br> This case highlights the importance of multimodal retinal imaging in diagnosing polypoidal choroidal vasculopathy and identifying associated neovascular activity.