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Lee SE, Lim HB, Shin YI, Ryu CK, Lee WH, Kim JY. Characteristics of the inner retinal layer in the fellow eyes of patients with unilateral exudative age-related macular degeneration. PLoS One 2020; 15:e0239555. [PMID: 32966311 PMCID: PMC7511006 DOI: 10.1371/journal.pone.0239555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 09/08/2020] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE To investigate the thicknesses of the ganglion cell-inner plexiform layer (GC-IPL) and retinal nerve fiber layer (RNFL) of the fellow eyes of patients with unilateral exudative age-related macular degeneration (AMD). METHODS A total of 107 patients with unilateral exudative AMD [34 of typical choroidal neovascularization (tCNV), Group A; 73 of polypoidal choroidal vasculopathy (PCV), Group B] and 73 normal control eyes (Group C) were included. Drusen and subretinal drusenoid deposits were assessed in all participants using fundus photography, autofluorescence, and optical coherence tomography (OCT). The GC-IPL and RNFL thicknesses were measured using Cirrus HD-OCT and compared among groups. Linear regression analyses were used to evaluate the factors associated with GC-IPL thicknesses. RESULTS The average GC-IPL thicknesses of Groups A, B, and C were 77.09 ± 3.87, 80.10 ± 6.61, and 80.88 ± 6.50 μm, respectively (p = 0.022). Sectoral GC-IPLs and central macular thicknesses (CMTs) were significantly different among groups (all, p <0.05), whereas none of the RNFL parameters differed significantly (all, p >0.05). Multivariate linear regression analyses revealed that age (p <0.001), CMT (p <0.001), and tCNV (p = 0.013) were significantly associated with average GC-IPL thickness, and the rate of reduction of GC-IPL thickness with increasing age in the fellow eyes of tCNV patients was higher than those in the PCV and control groups. CONCLUSIONS Unilateral tCNV patients exhibited statistically significant reduction of the GC-IPL thickness in the fellow eyes, compared to values of the fellow eyes of unilateral PCV patients or control patients. RNFL values trended to be lower but did not reach statistical significance.
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Affiliation(s)
- Seong Eun Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Hyung Bin Lim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Yong Il Shin
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
- Rhee’s Eye Hospital, Daejeon, Republic of Korea
| | - Cheon Kuk Ryu
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Woo Hyuk Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jung-Yeul Kim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
- * E-mail:
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Venkatesh R, Gadde SGK, Pereira A, Singh V, Sangai S, Sridharan A, Bavaharan B, Jain N, Yadav NK. Impact of sub-foveal choroidal thickness on clinical features and long-term clinical outcomes in polypoidal choroidal vasculopathy. Int Ophthalmol 2020; 41:87-97. [PMID: 32844237 DOI: 10.1007/s10792-020-01555-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To study the clinical features and long-term clinical outcomes in polypoidal choroidal vasculopathy (PCV) in eyes with different sub-foveal choroidal thickness (SFCT). METHODS In this retrospective, observational comparative study, treatment-naïve eyes diagnosed with PCV using the 'EVEREST-2' study criteria were included. The eyes were divided into three groups of thin, medium and thick choroids, based on the SFCT data of total study eyes. Demographic, clinical, imaging features and treatment outcomes between the 3 groups were compared. RESULTS Sixty-three eyes in 63 patients were included. Right eye was involved in 39 (61%) cases and left eye in 24 (39%) cases. Mean age was 68.3 ± 6.82 years (range 54-85 years). Mean SFCT was 274 µm (median = 269 µm), and one standard deviation was 79.2 µm. Totally, 11, 43 and 9 eyes were included in the thin, medium and thick choroid groups, respectively. The mean SFCT was 161 ± 24.1 µm, 275 ± 39.6 µm and 412 ± 26.2 µm in the thin, medium and thick choroid groups, respectively. There was no statistically significant difference in the clinical and imaging features and treatment outcomes between eyes with thin, medium and thick SFCT. CONCLUSION Eyes with PCV can have a choroid of varying thicknesses. Clinical, imaging and treatment responses were similar between the three sub-foveal choroidal thickness groups in this study. In future, more studies are required to evaluate the role of the choroidal thickness and its relationship to treatment in PCV.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina-Vitreous, Narayana Nethralaya, 121/C, Chord Road, 1st 'R' Block, Rajaji Nagar, Benguluru, 560010, India.
| | - Santosh Gopi Krishna Gadde
- Department of Retina-Vitreous, Narayana Nethralaya, 121/C, Chord Road, 1st 'R' Block, Rajaji Nagar, Benguluru, 560010, India
| | - Arpitha Pereira
- Department of Retina-Vitreous, Narayana Nethralaya, 121/C, Chord Road, 1st 'R' Block, Rajaji Nagar, Benguluru, 560010, India
| | - Vivek Singh
- Department of Retina-Vitreous, Narayana Nethralaya, 121/C, Chord Road, 1st 'R' Block, Rajaji Nagar, Benguluru, 560010, India
| | - Sajjan Sangai
- Department of Retina-Vitreous, Narayana Nethralaya, 121/C, Chord Road, 1st 'R' Block, Rajaji Nagar, Benguluru, 560010, India
| | - Akhila Sridharan
- Department of Retina-Vitreous, Narayana Nethralaya, 121/C, Chord Road, 1st 'R' Block, Rajaji Nagar, Benguluru, 560010, India
| | - Bharathi Bavaharan
- Department of Retina-Vitreous, Narayana Nethralaya, 121/C, Chord Road, 1st 'R' Block, Rajaji Nagar, Benguluru, 560010, India
| | - Nimesh Jain
- Department of Retina-Vitreous, Narayana Nethralaya, 121/C, Chord Road, 1st 'R' Block, Rajaji Nagar, Benguluru, 560010, India
| | - Naresh Kumar Yadav
- Department of Retina-Vitreous, Narayana Nethralaya, 121/C, Chord Road, 1st 'R' Block, Rajaji Nagar, Benguluru, 560010, India
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Cheung CMG, Lai TYY, Teo K, Ruamviboonsuk P, Chen SJ, Kim JE, Gomi F, Koh AH, Kokame G, Jordan-Yu JM, Corvi F, Invernizzi A, Ogura Y, Tan C, Mitchell P, Gupta V, Chhablani J, Chakravarthy U, Sadda SR, Wong TY, Staurenghi G, Lee WK. Polypoidal Choroidal Vasculopathy: Consensus Nomenclature and Non-Indocyanine Green Angiograph Diagnostic Criteria from the Asia-Pacific Ocular Imaging Society PCV Workgroup. Ophthalmology 2020; 128:443-452. [PMID: 32795496 DOI: 10.1016/j.ophtha.2020.08.006] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To develop consensus terminology in the setting of polypoidal choroidal vasculopathy (PCV) and to develop and validate a set of diagnostic criteria not requiring indocyanine green angiography (ICGA) for differentiating PCV from typical neovascular age-related macular degeneration (nAMD) based on a combination of OCT and color fundus photography findings. DESIGN Evaluation of diagnostic test results. PARTICIPANTS Panel of retina specialists. METHODS As part of the Asia-Pacific Ocular Imaging Society, an international group of experts surveyed and discussed the published literature regarding the current nomenclature and lesion components for PCV, and proposed an updated consensus nomenclature that reflects our latest understanding based on imaging and histologic reports. The workgroup evaluated a set of diagnostic features based on OCT images and color fundus photographs for PCV that may distinguish it from typical nAMD and assessed the performance of individual and combinations of these non-ICGA features, aiming to propose a new set of diagnostic criteria that does not require the use of ICGA. The final recommendation was validated in 80 eyes from 2 additional cohorts. MAIN OUTCOME MEASURES Consensus nomenclature system for PCV lesion components and non-ICGA-based criteria to differentiate PCV from typical nAMD. RESULTS The workgroup recommended the terms polypoidal lesion and branching neovascular network for the 2 key lesion components in PCV. For the diagnosis of PCV, the combination of 3 OCT-based major criteria (sub-retinal pigment epithelium [RPE] ring-like lesion, en face OCT complex RPE elevation, and sharp-peaked PED) achieved an area under the receiver operating characteristic curve of 0.90. Validation of this new scheme in a separate subset 80 eyes achieved an accuracy of 82%. CONCLUSIONS We propose updated terminology for PCV lesion components that better reflects the nature of these lesions and is based on international consensus. A set of practical diagnostic criteria applied easily to spectral-domain OCT results can be used for diagnosing PCV with high accuracy in clinical settings in which ICGA is not performed routinely.
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Affiliation(s)
- Chui M Gemmy Cheung
- Medical Retina Department, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore.
| | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong, China
| | - Kelvin Teo
- Medical Retina Department, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
| | | | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Judy E Kim
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Fumi Gomi
- Department of Ophthalmology, Hyogo College of Medicine, Hyogo, Japan
| | - Adrian H Koh
- Medical Retina Department, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore; Eye and Retina Surgeons, Camden Medical Centre, Singapore, Republic of Singapore
| | - Gregg Kokame
- Division of Ophthalmology, Department of Surgery, University of Hawaii School of Medicine, Honolulu, Hawaii
| | - Janice Marie Jordan-Yu
- Medical Retina Department, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Federico Corvi
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Milan, Italy; Save Sight Institute, Faculty of Health and Medicine, The University of Sydney, Sydney, Australia
| | - Yuichiro Ogura
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Colin Tan
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Republic of Singapore
| | - Paul Mitchell
- Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Vishali Gupta
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Jay Chhablani
- University of Pittsburgh Eye Center, Pittsburgh, Pennsylvania
| | - Usha Chakravarthy
- Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore; School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, United Kingdom
| | - Srinivas R Sadda
- Doheny Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Tien Y Wong
- Medical Retina Department, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Milan, Italy
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Tan CS, Lim LW, Ngo WK, Pannirselvam P, See C, Chee WK, Saxena N. Predictors of persistent disease activity following anti-VEGF loading dose for nAMD patients in Singapore: the DIALS study. BMC Ophthalmol 2020; 20:324. [PMID: 32762659 PMCID: PMC7409440 DOI: 10.1186/s12886-020-01582-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/22/2020] [Indexed: 12/03/2022] Open
Abstract
Background To determine the frequency of persistent disease activity following 3 loading doses of anti- vascular endothelial growth factor (VEGF) agents, and the anatomic and demographic predictors of early persistent disease activity among patients with neovascular age-related macular degeneration (nAMD). Methods In a retrospective real-world cohort study, 281 consecutive patients with nAMD were reviewed at baseline and after 3 anti-VEGF injections for pre-defined indicators of disease activity. Optical coherence tomography (OCT) features such as subretinal fluid, intraretinal cysts and intraretinal fluid were assessed by reading-center certified graders. Multiple logistic regression was performed on demographic and anatomic factors. Results At month 3, 66.1% of patients had persistent disease activity. The best-corrected visual acuity (BCVA) improvement was 0.16 LogMAR for those with no disease activity compared to 0 for patients with persistent activity (p < 0.001). The significant risk factors for persistent activity at 3 months were male gender (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.32–0.93, p = 0.025), intraretinal cysts at baseline (OR 2.95, 95% CI 1.67–5.20, p < 0.001) and subretinal fluid at baseline (OR 3.17, 95% CI 1.62–6.18, p = 0.002). At 3 months, 58% of patients had features of activity on OCT. Patients with intraretinal cysts and intraretinal fluid at baseline had worse BCVA at month 3 compared to patients without these OCT features (0.69 vs. 0.43, p < 0.001, and 0.62 vs. 0.43, p < 0.001, respectively). Conclusions In a real-world study, 66.1% of nAMD patients have persistent disease activity after the initial loading dose, with poorer BCVA compared to those without. Baseline OCT features (intraretinal cysts and subretinal fluid) are useful predictors of persistent disease activity at month 3.
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Affiliation(s)
- Colin S Tan
- Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore, Singapore. .,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore. .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. .,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.
| | - Louis W Lim
- Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Wei Kiong Ngo
- Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Pandiyan Pannirselvam
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Clarence See
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Wai Kitt Chee
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Nakul Saxena
- Novartis (Singapore) Private Limited, Singapore, Singapore
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DIFFERENCE BETWEEN PACHYCHOROID AND NONPACHYCHOROID POLYPOIDAL CHOROIDAL VASCULOPATHY AND THEIR RESPONSE TO ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY. Retina 2020; 40:1403-1411. [DOI: 10.1097/iae.0000000000002583] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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56
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Xu Z, Wang W, Yang J, Zhao J, Ding D, He F, Chen D, Yang Z, Li X, Yu W, Chen Y. Automated diagnoses of age-related macular degeneration and polypoidal choroidal vasculopathy using bi-modal deep convolutional neural networks. Br J Ophthalmol 2020; 105:561-566. [PMID: 32499330 DOI: 10.1136/bjophthalmol-2020-315817] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/31/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023]
Abstract
AIMS To investigate the efficacy of a bi-modality deep convolutional neural network (DCNN) framework to categorise age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) from colour fundus images and optical coherence tomography (OCT) images. METHODS A retrospective cross-sectional study was proposed of patients with AMD or PCV who came to Peking Union Medical College Hospital. Diagnoses of all patients were confirmed by two retinal experts based on diagnostic gold standard for AMD and PCV. Patients with concurrent retinal vascular diseases were excluded. Colour fundus images and spectral domain OCT images were taken from dilated eyes of patients and healthy controls, and anonymised. All images were pre-labelled into normal, dry or wet AMD or PCV. ResNet-50 models were used as the backbone and alternate machine learning models including random forest classifiers were constructed for further comparison. For human-machine comparison, the same testing data set was diagnosed by three retinal experts independently. All images from the same participant were presented only within a single partition subset. RESULTS On a test set of 143 fundus and OCT image pairs from 80 eyes (20 eyes per-group), the bi-modal DCNN demonstrated the best performance, with accuracy 87.4%, sensitivity 88.8% and specificity 95.6%, and a perfect agreement with diagnostic gold standard (Cohen's κ 0.828), exceeds slightly over the best expert (Human1, Cohen's κ 0.810). For recognising PCV, the model outperformed the best expert as well. CONCLUSION A bi-modal DCNN for automated classification of AMD and PCV is accurate and promising in the realm of public health.
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Affiliation(s)
- Zhiyan Xu
- Department of Ophthalmology, Peking Union Medical College Hospital, Dongcheng District, Beijing, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weisen Wang
- AI & Media Computing Lab, School of Information, Renmin University of China, Beijing, China
| | - Jingyuan Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Dongcheng District, Beijing, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianchun Zhao
- Vistel AI Lab, Visionary Intelligence Ltd, Beijing, China
| | - Dayong Ding
- Vistel AI Lab, Visionary Intelligence Ltd, Beijing, China
| | - Feng He
- Department of Ophthalmology, Peking Union Medical College Hospital, Dongcheng District, Beijing, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Di Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Dongcheng District, Beijing, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhikun Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Dongcheng District, Beijing, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xirong Li
- Department for state-of-the-art ophthalmology AI research & development, Key Lab of DEKE, Renmin University of China, Beijing, China
| | - Weihong Yu
- Department of Ophthalmology, Peking Union Medical College Hospital, Dongcheng District, Beijing, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Dongcheng District, Beijing, China .,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Schworm B, Luft N, Keidel LF, Herold TR, Wolf A, Priglinger SG, Siedlecki J. Ranibizumab non-response in pachychoroid neovasculopathy: Effects of switching to aflibercept. Sci Rep 2020; 10:8439. [PMID: 32439930 PMCID: PMC7242401 DOI: 10.1038/s41598-020-65370-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/20/2020] [Indexed: 12/27/2022] Open
Abstract
Non-response to intravitreal ranibizumab represents a frequent problem in pachychoroid neovasculopathy (PNV). To investigate the effectivity of switching to aflibercept, the database of the Ludwig Maximilians University, Munich, was screened for patients fulfilling the following inclusion criteria: (i) diagnosis of PNV; (ii) inadequate response to ≥ 3 ranibizumab injections, in spite of monthly dosing, defined as persistence of subretinal-fluid four weeks after the last ranibizumab injection; (iii) resulting switch to aflibercept administered as three monthly injections. Primary outcome measure was percentage of eyes with a dry macula four weeks after the third aflibercept injection. Secondary outcome measures included changes in maximum subretinal fluid (SRF), central subfield thickness (CST) and subfoveal choroidal thickness (SFCT). In total, 14 eyes of 14 patients were included. Mean age was 64.1 ± 7.5 (range: 51–78) years. Switching to aflibercept was performed after mean 8.4 ± 4.1 (3–15) ranibizumab injections. While no eye (0%) achieved a dry macula status during ranibizumab treatment, switching to aflibercept achieved a dry macula status in eight eyes (57.1%) after three injections. While both ranibizumab and aflibercept showed an effect on CST (p = 0.027, p = 0.003), only aflibercept showed a significant effect on SRF (p = 0.0009) and SFCT (p = 0.044). In cases of PNV not responding to intravitreal ranibizumab, switching treatment to aflibercept induces a favorable short-term response resolving persistent fluid and achieving a dry macula. Further studies with longer follow-up are warranted.
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Affiliation(s)
- Benedikt Schworm
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | - Nikolaus Luft
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | - Leonie F Keidel
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | - Tina R Herold
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | - Armin Wolf
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | | | - Jakob Siedlecki
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.
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Chaikitmongkol V, Cheung CMG, Koizumi H, Govindahar V, Chhablani J, Lai TY. Latest Developments in Polypoidal Choroidal Vasculopathy: Epidemiology, Etiology, Diagnosis, and Treatment. Asia Pac J Ophthalmol (Phila) 2020; 9:260-268. [PMID: 32332215 PMCID: PMC7299215 DOI: 10.1097/01.apo.0000656992.00746.48] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/01/2020] [Indexed: 12/25/2022] Open
Abstract
Polypoidal choroidal vasculopathy (PCV) is a condition characterized by multiple, recurrent, serosanguineous pigment epithelial detachments, and neurosensory retinal detachments due to abnormal aneurysmal neovascular lesions. It is generally considered as a variant of neovascular age-related macular degeneration, but there are some differences between the clinical presentation, natural history, and treatment response between patients with PCV and typical neovascular age-related macular degeneration patients. Over the past decade, new research and technological advancements have greatly improved our understanding of the PCV disease process and the management of PCV. This review aims to summarize the recent research findings to highlight the epidemiology, pathogenesis, genetics, the application of various diagnostic tools for PCV, and the available treatment options for PCV.
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Affiliation(s)
- Voraporn Chaikitmongkol
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
| | - Hideki Koizumi
- Department of Ophthalmology, University of the Ryukyus, Okinawa, Japan
| | - Vishal Govindahar
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Timothy Y.Y. Lai
- Hong Kong Eye Hospital, Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- 2010 Retina & Macula Center, Kowloon, Hong Kong
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Kumar M, Moptom SE, Sen P, Khetan V, Bhende M, Sivaprasad S, Raman R. Prevalence of polypoidal choroidal vasculopathy in Indian population: Risk factors, clinical and imaging characteristics. PLoS One 2020; 15:e0231901. [PMID: 32343707 PMCID: PMC7188226 DOI: 10.1371/journal.pone.0231901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/02/2020] [Indexed: 11/18/2022] Open
Abstract
AIM To assess prevalence, clinical presentation and multimodal imaging characteristics of polypoidal choroidal vasculopathy (PCV) in a hospital-based setting in South India. METHODS Electronic medical records (EMR) of new patients presenting with suspected clinical signs of wet age-related macular degeneration (AMD) in a tertiary hospital from January to December 2016 were retrospectively analyzed using keywords and filtered for patient who underwent multimodal imaging. Clinical presentations were categorized into predominantly hemorrhagic, exudative or mixed pattern. The imaging features were compared in these clinical groups. The multimodal images were graded by two masked graders and discrepancies between them were settled by a senior arbitrator. RESULTS Of the 147 clinically suspicious cases of PCV out of 785 patients with clinical presentation of AMD as recorded in the EMR, 73 (49.7%) patients had a multimodal imaging diagnosis of PCV. There was no difference in the demography, distribution of polyps, ICGA and OCT characteristics in eyes presenting with hemorrhagic, exudative or mixed clinical features. CONCLUSION Approximately half of South Asian patients presenting with clinical features of neovascular AMD harbor PCV irrespective of their clinical presentation and so we recommend that multimodal imaging is done in all cases of suspicious neovascular AMD in Indian population.
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Affiliation(s)
- Meenakshi Kumar
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | | | - Parveen Sen
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Vikas Khetan
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Muna Bhende
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
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Yanagi Y. Pachychoroid disease: a new perspective on exudative maculopathy. Jpn J Ophthalmol 2020; 64:323-337. [PMID: 32318919 DOI: 10.1007/s10384-020-00740-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/23/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Pachychoroid, or the structural and functional abnormalities of the choroid, is one of the most important causes of exudative maculopathies. The purpose of this article is to review the current definitions of pachychoroid and their potential consequences. Most publications are from Asian countries. Although no consensus diagnosis has been reached, pachychoroid is defined by thickened choroid and choroidal vascular hyperpermeability, pachyvessels with inner choroidal attenuation; it is closely linked to pachydrusen. Although some studies suggest choroidal congestion may play a role in its pathogenesis, the exact causes of this condition are still unknown. Pachychoroid is associated with exudative maculopathies including central serous chorioretinopathy, pachychoroid neovasculopathy and polypoidal choroidal vasculopathy (PCV). It is widely accepted that macular neovascular membranes may develop secondary to pachychoroid. Recent clinical observations illustrate the importance of pachychoroid in the etiology of macular neovascularization including neovascular age-related macular degeneration (nAMD). CONCLUSION Pachychoroid is an important cause of exudative maculopathies. Both drusen and pachychoroid are increasingly recognized as important causes of macular neovascularization, and eyes formally categorized as typical nAMD or PCV can be further sub-categorized based on the presence or absence of pachychoroid and drusen. There is a need to develop a consensus definition, which will greatly enhance our understanding of pachychoroid and facilitate the development of individual interventions in pachychoroid diseases.
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Affiliation(s)
- Yasuo Yanagi
- Department of Ophthalmology, Asahikawa Medical University, Hokkaido, Japan. .,Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore.
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61
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Ngo WK, Chee WK, Tan CS, Lim TH. Comparing efficacy of reduced-fluence and standard-fluence photodynamic therapy in the treatment of polypoidal choroidal vasculopathy. BMC Ophthalmol 2020; 20:150. [PMID: 32293353 PMCID: PMC7161176 DOI: 10.1186/s12886-020-01419-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/31/2020] [Indexed: 11/25/2022] Open
Abstract
Background The EVEREST II study reported superior polyp closure rates and visual outcomes using combination standard photodynamic therapy (PDT) with intravitreal ranibizumab in the treatment of polypoidal choroidal vasculopathy (PCV). The optimal PDT protocol remains controversial and it is postulated that less intensive PDT strategies may reduce complications. We aimed to compare the efficacy of reduced and standard-fluence PDT. Methods Case-control review of 38 consecutive PDT-naïve macular PCV patients who underwent verteporfin PDT using one of two PDT regimens at a tertiary referral centre in an Asian population. Comparison of outcomes between standard-fluence PDT (light dose, 50 J/cm2; dose rate, 600 mW/cm2; wavelength, 689 nm PDT applied to the treatment eye for 83 s) and reduced-fluence PDT (light dose, 25 J/cm2; dose rate, 600 mW/cm2; wavelength, 689 nm PDT applied to the treatment eye for 42 s). Primary outcome measure was best corrected LogMAR visual acuity (VA). Secondary outcome measures included OCT measurements such as central retinal thickness (CRT), height of subfoveal sub-retinal fluid (SRF), central choroid thickness (CCT), mean number of PDT treatments needed, mean number of anti-VEGF injections needed, polyp closure and recurrence rates. Results Of these 38 eyes of 38 patients, an equal number of eyes (19 in each arm) were treated with standard-fluence and reduced-fluence PDT. Mean letter gain at 12 months for the standard-fluence group was 6.0 compared to 4.3 letters for the reduced-fluence group (p = 0.61). Similar results were observed at all time points. There was no statistically significant difference between the retinal and choroidal anatomical OCT outcomes, rates of polyp closure and recurrences between the two PDT regimens. Conclusions Reduced-fluence PDT was comparable to standard-fluence PDT in the treatment of PCV in terms of visual gains, clinical and anatomical OCT outcomes.
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Affiliation(s)
- Wei Kiong Ngo
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore, Singapore
| | - Wai Kitt Chee
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Colin S Tan
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore. .,Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore, Singapore.
| | - Tock Han Lim
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore, Singapore
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62
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Chaikitmongkol V, Kong J, Khunsongkiet P, Patikulsila D, Sachdeva M, Chavengsaksongkram P, Dejkriengkraikul C, Winaikosol P, Choovuthayakorn J, Watanachai N, Kunavisarut P, Ingviya T, Bressler NM. Sensitivity and Specificity of Potential Diagnostic Features Detected Using Fundus Photography, Optical Coherence Tomography, and Fluorescein Angiography for Polypoidal Choroidal Vasculopathy. JAMA Ophthalmol 2020; 137:661-667. [PMID: 30973593 DOI: 10.1001/jamaophthalmol.2019.0565] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The use of indocyanine green angiography (ICGA) is a criterion standard for diagnosing polypoidal choroidal vasculopathy (PCV), an endemic and common cause of vision loss in Asian and African individuals that also presents in white individuals. However, the use of ICGA is expensive, invasive, and not always available at clinical centers. Therefore, knowing the value of certain features detected using fundus photography (FP), optical coherence tomography (OCT), and fluorescein angiography (FA) to diagnose PCV without ICGA could assist ophthalmologists to identify PCV when ICGA is not readily available. Objective To explore the sensitivity, specificity, and predictive accuracy of potential diagnostic features detected using FP, OCT, and FA in diagnosing PCV without ICGA. Design, Setting, and Participants Deidentified images of FP alone, OCT alone, and FA alone were graded by 3 retina specialists masked to ICGA findings for potentially diagnostic features of PCV prespecified before grading compared with the criterion standard grading of 2 other retina specialists with access simultaneously to FP, OCT, FA and ICGA. Specialists graded images of 124 eyes of 120 patients presenting between January 1, 2013, and December 31, 2016, with newly identified serous or serosanguinous maculopathy who had undergone FP, OCT, FA, and ICGA before treatment at a large referral eye center in Thailand. Main Outcomes and Measures Sensitivity, specificity, positive predictive value, negative predictive value, and predictive accuracy from the area under the receiver operating characteristic curve (AUC). Results The mean (SD) age of the patients was 57.7 (12.6) years, 52 were women, 68 were men, and the diagnosis (from ICGA) was PCV for 65 eyes (52.4%), central serous chorioretinopathy for 45 eyes (36.3%), and typical neovascular age-related macular degeneration for 12 eyes (9.7%). With the use of FP, a potential diagnostic feature for PCV was notched or hemorrhagic pigment epithelial detachment (AUC, 0.77; 95% CI, 0.70-0.85). With the use of OCT, potential diagnostic features for PCV were pigment epithelial detachment notch (AUC, 0.90; 95% CI, 0.85-0.96), sharply peaked pigment epithelial detachment (AUC, 0.86; 95% CI, 0.80-0.92), and a hyperreflective ring (AUC, 0.86; 95% CI, 0.80-0.92). When at least 2 of these 4 signs were present, the AUC was 0.93 (95% CI, 0.89-0.98), with a sensitivity of 0.95 (95% CI, 0.87-0.99), a specificity of 0.95 (95% CI, 0.82-0.97), a positive predictive value of 0.92 (95% CI, 0.83-0.97), and a negative predictive value of 0.95 (95% CI, 0.86-0.99). Conclusions and Relevance These data suggest that the potential diagnostic features detected using FP and OCT provide high sensitivity and specificity for a diagnosis of PCV, especially when at least 2 of 4 highly suggestive signs are present.
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Affiliation(s)
| | - Jun Kong
- Wilmer Eye Institute, Retina Division, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Direk Patikulsila
- Retina Division, Department of Ophthalmology, Chiang Mai University, Chiang Mai, Thailand
| | - Mira Sachdeva
- Wilmer Eye Institute, Retina Division, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Pawara Winaikosol
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Nawat Watanachai
- Retina Division, Department of Ophthalmology, Chiang Mai University, Chiang Mai, Thailand
| | - Paradee Kunavisarut
- Retina Division, Department of Ophthalmology, Chiang Mai University, Chiang Mai, Thailand
| | - Thammasin Ingviya
- Department of Family Medicine and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Thailand
| | - Neil M Bressler
- Wilmer Eye Institute, Retina Division, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Editor
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63
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Choi EY, Park SE, Lee SC, Koh HJ, Kim SS, Byeon SH, Kim M, Lee CS. Long-Term Incidence and Growth of Chorioretinal Atrophy in Patients with Polypoidal Choroidal Vasculopathy. Ophthalmologica 2019; 243:136-144. [PMID: 31454801 DOI: 10.1159/000501724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/25/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate the long-term incidence and growth rate of chorioretinal atrophy (CRA) in patients with polypoidal choroidal vasculopathy (PCV) and determine the associated risk factors. METHODS The medical records of 88 patients with unilateral symptomatic PCV who received anti-vascular endothelial growth factor (anti-VEGF) injections with or without photodynamic therapy (PDT) were analyzed retrospectively. Near-infrared fundus imaging and spectral domain optical coherence tomography were used to measure the CRA area and growth rate. Kaplan-Meier survival analysis was performed to estimate the CRA incidence. Logistic and linear regression analyses were used to investigate risk factors (e.g., age, frequency of abnormal OCT findings, PDT history, total injection number, and choroidal thickness) associated with the CRA incidence and growth rate, respectively. RESULTS The overall CRA incidence was 40.8% at 5 years. The absence of subretinal fluid, the presence of intraretinal fluid, and a thin choroid were significant risk factors for CRA occurrence with a history of PDT. Overall 5-year CRA growth rate was 0.69 mm2/year. Faster CRA growth was significantly related to the presence of subretinal hyperreflective material and thin choroid. PDT history was not significantly related to CRA growth. CONCLUSIONS Thin choroid may be a significant risk factor for long-term development and growth of CRA in eyes with PCV. Intraretinal fluid seems to promote the development of CRA, while subretinal fluid seems to be associated with CRA prevention. The history of PDT was significantly related to the occurrence of CRA, but not to the growth rate of CRA.
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Affiliation(s)
- Eun Young Choi
- Department of Ophthalmology, The Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Eun Park
- Department of Ophthalmology, The Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Chul Lee
- Department of Ophthalmology, The Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyoung Jun Koh
- Department of Ophthalmology, The Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Soo Kim
- Department of Ophthalmology, The Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, The Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Kim
- Department of Ophthalmology, The Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, The Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea, .,Department of Ophthalmology, The Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea,
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64
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Singh SR, Goyal P, Parameswarappa DC, Goud A, Chhablani J. Angiographic features of polypoidal choroidal vasculopathy using indocyanine green angiography and optical coherence tomography angiography: A comparative study. Eur J Ophthalmol 2019; 30:1076-1081. [PMID: 31113262 DOI: 10.1177/1120672119850075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND To compare the vascular lesion size using optical coherence tomography angiography and indocyanine green angiography in eyes with polypoidal choroidal vasculopathy. METHODS Treatment-naïve cases (46 eyes of 44 patients) with polypoidal choroidal vasculopathy were retrospectively analyzed. The comparison of mean area of branching vascular network and polyp detection rate was done between indocyanine green angiography and optical coherence tomography angiography and correlated with various optical coherence tomography features. RESULTS The mean age of the study patients was 62.33 ± 10.74 years. The mean branching vascular network size was 7.47 ± 5.74 and 7.51 ± 5.69 mm² in indocyanine green angiography and optical coherence tomography angiography, respectively, with an excellent correlation (r = 0.997). Optical coherence tomography angiography overestimated (mean ± SD: 0.28 ± 0.19 mm²) and underestimated branching vascular network area (0.36 ± 0.33 mm²) in 23 eyes each as compared to indocyanine green angiography. However, the difference in branching vascular network size was not statistically significant (p = 0.53). Indocyanine green angiography and optical coherence tomography angiography could identify polyps in 43 of 46 (93.48%) and 32 of 46 (69.57%) patients, respectively. CONCLUSION Branching vascular network size measurements with indocyanine green angiography and optical coherence tomography angiography were comparable and showed significant correlation, albeit the polyp identification rate was lower with optical coherence tomography angiography. Optical coherence tomography angiography may serve as a useful substitute to indocyanine green angiography in measurements of branching vascular network for photodynamic therapy and follow-up of polypoidal choroidal vasculopathy eyes.
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Affiliation(s)
- Sumit Randhir Singh
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India.,Retina and Uveitis Department, LV Prasad Eye Institute, Visakhapatnam, India
| | - Prakhar Goyal
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India.,Academy for Eye Care Education, L V Prasad Eye Institute, Hyderabad, India
| | - Deepika C Parameswarappa
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India.,Academy for Eye Care Education, L V Prasad Eye Institute, Hyderabad, India
| | - Abhilash Goud
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Jay Chhablani
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
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65
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Tan CS, Ting DS, Lim LW. Multicolor Fundus Imaging of Polypoidal Choroidal Vasculopathy. ACTA ACUST UNITED AC 2019; 3:400-409. [DOI: 10.1016/j.oret.2019.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 12/05/2018] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
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66
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Anti-Vascular Endothelial Growth Factor Resistance in Exudative Macular Degeneration and Polypoidal Choroidal Vasculopathy. Ophthalmol Retina 2019; 3:744-752. [PMID: 31511169 DOI: 10.1016/j.oret.2019.04.018] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/04/2019] [Accepted: 04/16/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the prevalence of polypoidal choroidal vasculopathy (PCV) in different ethnic populations and to determine the prevalence of PCV in eyes with exudative age-related macular degeneration (AMD) that is sensitive and resistant to anti-vascular endothelial growth factor (VEGF) therapy. DESIGN Retrospective chart review. PARTICIPANTS Two hundred fifty-three eyes of 221 patients with exudative AMD. METHODS Baseline data were collected on all eyes diagnosed with exudative AMD, which included ethnic data. Polypoidal choroidal vasculopathy was diagnosed using indocyanine green angiography (ICGA) with the scanning laser ophthalmoscope. Exudative AMD eyes were separated into 2 groups: anti-VEGF-resistant eyes with persistent subretinal fluid, subretinal hemorrhage, or macular edema after 4 anti-VEGF injections and anti-VEGF-sensitive eyes defined as eyes without residual disease activity. The prevalence of PCV was determined in each group based on ICGA. MAIN OUTCOME MEASURES Prevalence of PCV in exudative AMD, and in different ethnic populations, and prevalence of anti-VEGF resistance in eyes with and without PCV. RESULTS Exudative AMD was diagnosed in 253 eyes of 221 patients. Polypoidal choroidal vasculopathy was noted to have a prevalence of 45.1% (114/253 eyes) in the overall population. Polypoidal choroidal vasculopathy was noted in 51.6% (81/157) of eyes with wet AMD in Asians, 31.9% (23/72 eyes) of eyes with wet AMD in white persons, and 28.6% (4/14 eyes) in a small group of Pacific Islanders. Polypoidal choroidal vasculopathy was diagnosed in 50% (60/120 eyes) of eyes in the anti-VEGF-resistant group, which is more prevalent than the 30.2% (29/96 eyes) in the anti-VEGF-sensitive group (P < 0.001). CONCLUSIONS Polypoidal choroidal vasculopathy is more prevalent in Asian patients with exudative AMD, but is more prevalent than generally recognized in white patients. Polypoidal choroidal vasculopathy is more prevalent in anti-VEGF-resistant eyes in both white and Asian patients, which could help to predict therapeutic response.
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67
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Tan CS, Ting DS, Lim LW. Multicolour imaging for the detection of polypoidal choroidal vasculopathy and age-related macular degeneration. Clin Exp Ophthalmol 2019; 47:621-630. [DOI: 10.1111/ceo.13462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/20/2018] [Accepted: 12/12/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Colin S. Tan
- Fundus Image Reading Centre; National Healthcare Group Eye Institute; Singapore Singapore
- National Healthcare Group Eye Institute; Tan Tock Seng Hospital; Singapore Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School; Singapore Singapore
- Lee Kong Chian School of Medicine; Nanyang Technological University; Singapore Singapore
| | - Dominic S. Ting
- National Healthcare Group Eye Institute; Tan Tock Seng Hospital; Singapore Singapore
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
| | - Louis W. Lim
- National Healthcare Group Eye Institute; Tan Tock Seng Hospital; Singapore Singapore
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68
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Tan CS, Ngo WK, Lim LW, Tan NW, Lim TH. EVEREST study report 4: Fluorescein angiography features predictive of polypoidal choroidal vasculopathy. Clin Exp Ophthalmol 2019; 47:614-620. [PMID: 30652395 PMCID: PMC6767036 DOI: 10.1111/ceo.13464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/18/2018] [Accepted: 12/12/2018] [Indexed: 12/01/2022]
Abstract
Importance It is important to identify features of polypoidal choroidal vasculopathy (PCV) that differentiate it from typical neovascular age‐related macular degeneration (nAMD) on various imaging modalities, including fluorescein angiography (FA). Background PCV was thought to be indistinguishable from nAMD using FA alone. In real‐world practice, indocyanine‐green angiography may often be unavailable or contraindicated. Design Analysis of FA images from a prospective, multicentre study. Participants Study images of both PCV and nAMD patients from the EVEREST study. Methods FA features at baseline were independently graded by masked graders (fellowship‐trained ophthalmologists) using standardized diagnostic algorithms. Main Outcome Measures Predictive indicators (sensitivity, specificity, positive and negative predictive values) for PCV. Results Of the 95 patients screened, 61 had PCV. Of the 34 screening failures, 15 were diagnosed as nAMD. Hyperfluorescent nodules on FA were observed in 80% of patients with PCV vs 20% with nAMD (P < 0.001). Blocked fluorescence on FA, which corresponded to the presence of subretinal haemorrhage, occurred more frequently among patients with PCV vs nAMD (61.7% vs 13.3%, P = 0.001). Similarly, the leakage characteristic of occult choroidal neovascularization occurred more frequently among patients with PCV vs nAMD (95.0% vs 73.3%, P = 0.026). The positive predictive value for PCV was 94.1% for hyperfluorescent nodules, 94.9% for blocked fluorescence, 83.8% for occult choroidal neovascularization and 82.0% for pigment epithelial detachment. Conclusions and Relevance This study demonstrated that certain FA features can be predictive of PCV and may be considered as an indication for retina specialists to perform indocyanine green angiography as confirmatory test.
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Affiliation(s)
- Colin S Tan
- Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wei K Ngo
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Louis W Lim
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Nikolle W Tan
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Tock H Lim
- Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
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Abstract
Polypoidal choroidal vasculopathy (PCV) is a retinal disorder commonly found in Asians presenting as neovascular age-related macular degeneration and is characterized by serous macular detachment, serous or hemorrhagic pigment epithelial detachment, subretinal hemorrhage, and occasionally visible orange-red subretinal nodular lesions. PCV is diagnosed using indocyanine green angiography (ICGA), and the lesions appear as polypoidal aneurysmal vascular lesions with or without abnormal branching vascular network. Although ICGA remains the gold standard for the diagnosis of PCV, various imaging modalities have also facilitated the diagnosis and monitoring of PCV. Recent advances in imaging technology including the use of high resolution spectral domain optical coherence tomography (OCT) and OCT angiography have provided new insights on the pathogenesis of PCV, suggesting a link between PCV and pachychoroid spectrum of macular disorders. With the evolving understanding on the pathogenesis and clinical characteristics of PCV, different therapeutic options have been proposed. These include intravitreal anti-vascular endothelial growth factor (anti-VEGF) monotherapy, combination therapy with anti-VEGF and verteporfin photodynamic therapy, and thermal laser photocoagulation. In recent years, major multi-center randomized clinical trials such as EVEREST, EVEREST II, and PLANET studies have been conducted to compare the efficacy and safety of various treatment options for PCV. This review aims to summarize the results of recent literature, clinical trials and studies to provide an update on the management options of PCV. An overall management strategy for PCV will also be proposed.
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Affiliation(s)
- Christine P S Ho
- Faculty of Medicine, The University of Hong Kong; 2010 Retina and Macula Centre, Kowloon, Hong Kong SAR
| | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, The Chinese University of Hong Kong; 2010 Retina and Macula Centre, Kowloon, Hong Kong SAR
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70
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Abstract
Purpose of review The aim of this review is to summarize developments in the treatment of active polypoidal choroidal vasculopathy (PCV). PCV is associated with a poor visual prognosis as a consequence the condition's hallmark polypoidal dilatation and a branching network resulting in recurrent hemorrhages and serous leakage. Recent findings Recent research has provided new insights into the pathogenesis of PCV. While still considered a subtype of age-related macular degeneration, suggestions that PCV belongs to a spectrum of conditions that present with a pachychoroid are increasingly well accepted. Treatment remains challenging. Combination therapy (photodynamic therapy (PDT) and intravitreal anti-vascular endothelial growth factor (VEGF)) is associated with higher polyp closure rate, but polyp closure rate has not been correlated with superior visual outcomes. Current data points to non-inferiority of anti-VEGF alone versus combined with PDT when final vision acuity is the study outcome. Summary PCV remains a clinical challenge. Classification and treatment of the condition continues to evolve. Combination therapy may not be superior to anti-VEGF treatment alone in terms of visual acuity outcome, however data on long-term recurrence should be compared in formulating preferred treatment plans.
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71
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Zhang J, Yan Y, Yu Z, Liu L. Characteristics of Polypoidal Choroidal Vasculopathy Evaluated by Multispectral Imaging. Ophthalmic Surg Lasers Imaging Retina 2018; 49:e249-e255. [DOI: 10.3928/23258160-20181203-15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 04/25/2018] [Indexed: 11/20/2022]
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Tan CS, Lim LW, Ting DS. Choroidal remodeling after photodynamic therapy for polypoidal choroidal vasculopathy. Lasers Surg Med 2018; 50:978-979. [PMID: 29953625 DOI: 10.1002/lsm.22998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Colin S Tan
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Fundus Image Reading Center, National Healthcare Group Eye Institute, Singapore, Singapore
| | - Louis W Lim
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Dominic S Ting
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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73
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Acton JH, Ogino K, Akagi Y, Wild JM, Yoshimura N. Microperimetry and multimodal imaging in polypoidal choroidal vasculopathy. Sci Rep 2018; 8:15769. [PMID: 30361520 PMCID: PMC6202363 DOI: 10.1038/s41598-018-33781-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 10/07/2018] [Indexed: 11/10/2022] Open
Abstract
Polypoidal choroidal vasculopathy (PCV) is a degenerative macular disease. The study determined the topographical concordance in the areal extent of PCV, defined by indocyanine green angiography (ICGA), and the corresponding outcomes from spectral-domain optical coherence tomography (SD-OCT) and microperimetry, in 25 individuals (25 eyes) who had undergone 3 months of anti-vascular endothelial growth factor treatment. The differential light sensitivity within 10° eccentricity was evaluated by Pattern Deviation probability analysis. The concordances and proportional areal extents of the abnormality for ICGA, SD-OCT and microperimetry were compared. The concordance in the areal extent between all three modalities was 59%. The median concordance between ICGA and microperimetry was 60%; between ICGA and SD-OCT, 70%; and between SD-OCT and microperimetry, 72%. SD-OCT and microperimetry each identified a greater areal extent (>20%) compared to ICGA in 13 and 19 eyes, respectively. A greater areal extent (>20%) was present in 9 eyes for microperimetry compared to SD-OCT and in 5 eyes for SD-OCT compared to microperimetry. SD-OCT and microperimetry each identified a greater area of abnormality than ICGA which supports the clinical utility of SD-OCT. Strong concordance was present between SD-OCT and microperimetry; however, microperimetry identified additional areas of functional abnormality.
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Affiliation(s)
- Jennifer H Acton
- College of Biomedical and Life Sciences, Cardiff University, Maindy Road, Cardiff, Wales, CF24 4HQ, UK.
| | - Ken Ogino
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yumiko Akagi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - John M Wild
- College of Biomedical and Life Sciences, Cardiff University, Maindy Road, Cardiff, Wales, CF24 4HQ, UK
| | - Nagahisa Yoshimura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Arias JD, Hoyos AT, Parra MM, Gutierrez ÁJ, Sanchez-Avila RM. Characteristics of Polypoidal Choroidal Vasculopathy in OCT Angiography in Latin American Patients. Ophthalmic Surg Lasers Imaging Retina 2018; 49:748-756. [DOI: 10.3928/23258160-20181002-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 09/09/2018] [Indexed: 11/20/2022]
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The role of optical coherence tomography angiography in diagnosis of polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 2018; 256:1557-1558. [DOI: 10.1007/s00417-018-4018-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 05/23/2018] [Indexed: 10/14/2022] Open
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Anantharaman G, Sheth J, Bhende M, Narayanan R, Natarajan S, Rajendran A, Manayath G, Sen P, Biswas R, Banker A, Gupta C. Polypoidal choroidal vasculopathy: Pearls in diagnosis and management. Indian J Ophthalmol 2018; 66:896-908. [PMID: 29941728 PMCID: PMC6032720 DOI: 10.4103/ijo.ijo_1136_17] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Polypoidal choroidal vasculopathy (PCV) is increasingly recognized as an important cause of exudative maculopathy in Asians as against Wet age-related macular degeneration in Caucasians. A panel of retinal experts methodically evaluated pertinent updated literature on PCV with thorough PubMed/MEDLINE search. Based on this, the panel agreed upon and proposed the current consensus recommendations in the diagnosis (clinical and imaging), management and follow-up schedule of PCV. Diagnosis of PCV should be based on the gold standard indocyanine green angiography which demonstrates early nodular hyperfluorescence signifying the polyp with additional features such as abnormal vascular network (AVN). Optical coherence tomography is an excellent adjuvant for diagnosing PCV, monitoring disease activity, and decision-making regarding the treatment. Current treatment modalities for PCV include photodynamic therapy, anti-vascular endothelial growth factor agents, and thermal laser. Choice of specific treatment modality and prognosis depends on multiple factors such as the location and size of PCV lesion, presence or absence of polyp with residual AVN, amount of submacular hemorrhage, presence or absence of leakage on fundus fluorescein angiography, visual acuity, and so on. Current recommendations would be invaluable for the treating physician in diagnosing PCV and in formulating the best possible individualized treatment strategy for optimal outcomes in PCV management.
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Affiliation(s)
| | - Jay Sheth
- Department of Vitreoretina, Giridhar Eye Institute, Kochi, Kerala, India
| | - Muna Bhende
- Department of Vitreoretinal Services, Sri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Raja Narayanan
- Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sundaram Natarajan
- Department of Vitreoretina, Aditya Jyot Eye Hospital Pvt. Ltd., Mumbai, Maharashtra, India
| | - Anand Rajendran
- Retina-Vitreous Service, Aravind Eye Hospital, Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - George Manayath
- Department of Retina and Ocular Oncology, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Parveen Sen
- Department of Vitreoretinal Services, Sri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Rupak Biswas
- Department of Vitreoretina, B. B. Eye Foundation, Kolkata, West Bengal, India
| | - Alay Banker
- Bankers Retina Clinic and Laser Centre, Ahmedabad, Gujarat, India
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Clinical outcomes in Caucasian patients with polypoidal choroidal vasculopathy. Eye (Lond) 2018; 32:1731-1739. [PMID: 30002485 DOI: 10.1038/s41433-018-0168-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/13/2018] [Accepted: 06/15/2018] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To describe treatment outcomes in a cohort of Caucasian patients with polypoidal choroidal vasculopathy (PCV). METHODS Clinical charts from 48 eyes of 45 Caucasian patients with PCV were retrospectively reviewed. All cases were diagnosed with indocyanine green angiography. Best corrected visual acuity (BCVA) and optical coherence tomography (OCT) imaging were analyzed at baseline and final follow-up. RESULTS Eyes were treated with a combination of verteporfin photodynamic therapy (PDT) and anti-vascular endothelial growth factor (VEGF) (n = 24), or PDT monotherapy (n = 9), or anti-VEGF monotherapy (n = 8), or no treatment (n = 7). Aflibercept was the anti-VEGF agent in 30 out of 32 eyes. Sixteen out of 24 eyes in the combination treatment group received initial PDT at diagnosis. All treatments led to stabilization of BCVA at final visit with a trend for better visual acuity in the anti-VEGF monotherapy group. There was a substantial reduction in central retinal thickness associated with resolution of subfoveal fluid and improvement in retinal pigment epithelial detachment in all treatment groups. BCVA and OCT findings remained stable in eyes which received no treatment. The use of PDT was associated with 0.5 fewer intravitreal injections per annum, which was not statistically significant. CONCLUSIONS In the largest series of Caucasian patients with PCV presented to date, anti-VEGF monotherapy, PDT, or their combination preserved visual acuity and improved subfoveal exudative changes. Combination treatment was not superior to anti-VEGF monotherapy.
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Risk factors for breakthrough vitreous hemorrhage after intravitreal anti-VEGF injection in age-related macular degeneration with submacular hemorrhage. Sci Rep 2018; 8:10560. [PMID: 30002432 PMCID: PMC6043543 DOI: 10.1038/s41598-018-28938-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/28/2018] [Indexed: 11/19/2022] Open
Abstract
To investigate the risk factors for breakthrough vitreous hemorrhage (VH) after intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection in age-related macular degeneration (AMD) accompanied by submacular hemorrhage (SMH). We retrospectively reviewed the medical records of patients diagnosed with AMD combined with SMH, and enrolled 31 patients. We formed an age- and sex-matched control group of patients with submacular hemorrhage who did not develop breakthrough VH after intravitreal injection during 6 month follow-up. The mean patient age was 70.8 ± 10.3 years in the breakthrough VH group. Of the 31 patients, 8 were diagnosed with choroidal neovascularization (CNV), 22 with polypoidal choroidal vasculopathy (PCV), and 1 with retinal angiomatous proliferation (RAP). PCV was associated with a significantly higher incidence of VH (odds ratio, 35.01; p = 0.001). The size of the SMH was 22.7 ± 12.4 disc areas (DAs) in the breakthrough VH group and 5.4 ± 6.9 DAs in the control group, and was thus significantly related to the development of VH (p < 0.001). The risk of VH was significantly higher in those taking anticoagulants (p = 0.014). There was no significant difference between the types of anti-VEGF agents. When taking anticoagulant medications, a SMH of large diameter, and PCV subtype were risk factors for breakthrough VH after anti-VEGF injection.
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A comparison of risk factors for age-related macular degeneration and polypoidal choroidal vasculopathy in Chinese patients. Graefes Arch Clin Exp Ophthalmol 2018; 256:1449-1457. [PMID: 29858677 DOI: 10.1007/s00417-018-4020-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 03/27/2018] [Accepted: 05/23/2018] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV) are important vision-threatening diseases worldwide. For effective treatment, the risk factors for the diseases merit investigation. This study aimed to compare the risk factors for nAMD vs. PCV in Chinese patients. METHODS A total of 946 participants were recruited in this case-control study, including 281 patients with nAMD, 306 patients with PCV, and 359 controls. All participants underwent comprehensive ophthalmic examinations. Information on risk factors were collected by questionnaire. Multivariate logistic regression analyses were performed to investigate the difference in risk factors between nAMD and PCV. In a subgroup of subjects, serum lipid data were obtained and analyzed. RESULTS Risk factors for nAMD included older age (OR 1.03, P = 0.001), male gender (OR 1.55, P = 0.020), asthma (OR 2.50, P = 0.028), smoking (OR 1.92, P = 0.001), and family history (OR 6.82, P = 0.001), while smoking (OR 1.67, P = 0.013) was the only risk factor for PCV. Compared to patients with PCV, patients with nAMD were more likely to be older and suffer from hyperlipidemia, coronary artery disease, rheumatism, and tumor. Interestingly, higher levels of high-density lipoprotein were positively associated with PCV in the subgroup analysis (OR 7.74, P = 0.011). Besides, results were quite different between the combination of patients with nAMD and PCV and patients with nAMD or PCV alone. CONCLUSIONS The risk factors for nAMD and PCV is varying with the exception of smoking. Our findings suggest that different strategies might be applied in the clinical management and scientific research on nAMD and PCV.
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Cheung CMG, Lai TY, Ruamviboonsuk P, Chen SJ, Chen Y, Freund KB, Gomi F, Koh AH, Lee WK, Wong TY. Polypoidal Choroidal Vasculopathy. Ophthalmology 2018; 125:708-724. [DOI: 10.1016/j.ophtha.2017.11.019] [Citation(s) in RCA: 211] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/09/2017] [Accepted: 11/09/2017] [Indexed: 12/28/2022] Open
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Kang HG, Kang H, Byeon SH, Kim SS, Koh HJ, Lee SC, Kim M. Long-term visual outcomes for treatment of submacular haemorrhage secondary to polypoidal choroidal vasculopathy. Clin Exp Ophthalmol 2018; 46:916-925. [PMID: 29652440 DOI: 10.1111/ceo.13198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/01/2018] [Accepted: 04/03/2018] [Indexed: 11/30/2022]
Abstract
IMPORTANCE There is no consensus on the optimal management of submacular haemorrhage (SMH) secondary to polypoidal choroidal vasculopathy (PCV). BACKGROUND To compare the long-term outcome of three treatment strategies for PCV with SMH. DESIGN Retrospective case series at two tertiary hospitals. SAMPLES A total of 48 consecutive eyes treated between July 2006 and March 2016. METHODS Patients were grouped according to the treatment received: 22 eyes with intravitreal bevacizumab (IVB), 14 with a combination of IVB and pneumatic displacement (PD) and 12 with IVB and vitrectomy (TPPV). MAIN OUTCOME MEASURES Change in best-corrected visual acuity (BCVA) at onset and up to 24 months. Secondary measures included demographic data, imaging data and complications. RESULTS Comparing the mean BCVAs of the groups revealed significant differences only at month 1 (P = 0.005). Changes in the mean BCVA over time revealed no significance in the resulting final BCVA (P = 0.062), which was 20 out of 155 (logMAR 0.89 ± 0.64) for IVB monotherapy, 20 out of 174 (0.94 ± 1.04) for combined IVB + PD, and 20 out of 195 (0.99 ± 0.90) for combined IVB + TPPV eyes. Sustained long-term improvement of over three Snellen lines was found in seven (31.82%) IVB monotherapy, 10 (71.43%) combined IVB + PD, and seven (58.33%) combined IVB + TPPV eyes (P = 0.043). SMH recurrence was observed in two eyes after IVB monotherapy and one eye after combined IVB + PD (P = 0.786). CONCLUSIONS AND RELEVANCE IVB monotherapy appears to be as effective as combination therapies for treating SMH secondary to PCV with regards to BCVA at 24 months, and may be a cost-effective strategy for long-term management.
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Affiliation(s)
- Hyun Goo Kang
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyunseung Kang
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyoung Jun Koh
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Chul Lee
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Tan CS, Ngo WK, Lim LW. Visual outcomes of polypoidal choroidal vasculopathy treated with intravitreal ranibizumab with or without photodynamic therapy. Acta Ophthalmol 2018; 96:e254-e255. [PMID: 28456139 DOI: 10.1111/aos.13467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Colin S Tan
- National Healthcare Group Eye Institute, Singapore, Singapore.,Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore, Singapore
| | - Wei Kiong Ngo
- National Healthcare Group Eye Institute, Singapore, Singapore
| | - Louis W Lim
- National Healthcare Group Eye Institute, Singapore, Singapore
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83
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Tan CS, Ngo WK, Lim LW. Visual outcomes in patients with neovascular age-related macular degeneration. Acta Ophthalmol 2018; 96:e254. [PMID: 28834272 DOI: 10.1111/aos.13540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Colin S Tan
- National Healthcare Group Eye Institute, Singapore, Singapore.,Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore, Singapore
| | - Wei Kiong Ngo
- National Healthcare Group Eye Institute, Singapore, Singapore
| | - Louis W Lim
- National Healthcare Group Eye Institute, Singapore, Singapore
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84
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Kunavisarut P, Thithuan T, Patikulsila D, Choovuthayakorn J, Watanachai N, Chaikitmongkol V, Pathanapitoon K, Rothova A. Submacular Hemorrhage: Visual Outcomes and Prognostic Factors. Asia Pac J Ophthalmol (Phila) 2018; 7:109-113. [PMID: 29063740 DOI: 10.22608/apo.2017389] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To describe causes, visual outcomes, and prognostic factors in patients with submacular hemorrhage (SMH). DESIGN Retrospective case review. METHODS We performed a retrospective review of SMH with a size of at least 1 disc diameter. SMH causes were classified into 3 groups: 1) neovascular age-related macular degeneration (nAMD), 2) polypoidal choroidal vasculopathy (PCV), and 3) other miscellaneous causes. RESULTS Ninety-eight eyes of 98 patients were included. Based on clinical presentation and indocyanine green angiography (ICGA), the diagnoses of PCV (59%), nAMD (31%), and miscellaneous other causes (10%) were made. PCV patients were younger (P = 0.005) and had larger SMH size than nAMD patients (P = 0.008). Poor visual outcome [>1.0 logarithm of the minimum angle of resolution (logMAR)] at 6 months was associated with low initial visual acuity (VA; >1.0 logMAR; P = 0.002) and with the diagnosis of nAMD (P = 0.02). In addition, limited visual outcomes were noted for patients older than 65 years and those with persistent SMH for at least 2 months. CONCLUSIONS PCV was the most common cause of SMH in Thailand. ICGA represented a valuable tool for the diagnosis. Visual outcomes were limited for patients with nAMD and for patients who presented with poor initial VA.
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Affiliation(s)
- Paradee Kunavisarut
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tipparut Thithuan
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Direk Patikulsila
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Janejit Choovuthayakorn
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nawat Watanachai
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Voraporn Chaikitmongkol
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kessara Pathanapitoon
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Aniki Rothova
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
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Management of recalcitrant polypoidal choroidal vasculopathy by feeder vessel laser photocoagulation. Am J Ophthalmol Case Rep 2018; 9:112-115. [PMID: 29577101 PMCID: PMC5861743 DOI: 10.1016/j.ajoc.2018.01.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 10/27/2017] [Accepted: 01/10/2018] [Indexed: 11/29/2022] Open
Abstract
Purpose To describe management of residual branch vascular network (BVN) in polypoidal choroidal vasculopathy (PCV) by thermal laser photocoagulation of feeder vessel. Observations Case report of sixty-four year old female with polypoidal choroidal vaculopathy (PCV) with moderate response to seven doses of intravitreal ranibizumab, six doses of intravitreal bevacizumab and one session of photodynamic therapy (PDT). The patient has resolved polyps but persistence of disease activity due to residual BVN and large pigment epithelial detachment (PED). Patient underwent thermal laser photocoagulation of feeder vessel of BVN identified on indocyanine green angiography (ICGA). There was complete resolution of residual BVN and large PED, which was confirmed on ICGA. Conclusions and Importance Recalcitrant cases of PCV without polyps but having BVN with feeder vessel can be managed by ICGA guided thermal laser photocoagulation. The case report illustrates the importance of utilizing multimodal imaging such as video indocyanine green angiography (ICGA) for identification of feeder vessel and its deployment for optimal management of refractory PCV.
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86
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Tan CS, Hariprasad SM, Lim LW. New Paradigms in Polypoidal Choroidal Vasculopathy Management: The Impact of Recent Multicenter, Randomized Clinical Trials. Ophthalmic Surg Lasers Imaging Retina 2018; 49:4-10. [PMID: 29304260 DOI: 10.3928/23258160-20171215-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Koh A, Lai TYY, Takahashi K, Wong TY, Chen LJ, Ruamviboonsuk P, Tan CS, Feller C, Margaron P, Lim TH, Lee WK. Efficacy and Safety of Ranibizumab With or Without Verteporfin Photodynamic Therapy for Polypoidal Choroidal Vasculopathy: A Randomized Clinical Trial. JAMA Ophthalmol 2017; 135:1206-1213. [PMID: 28983556 DOI: 10.1001/jamaophthalmol.2017.4030] [Citation(s) in RCA: 209] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance Polypoidal choroidal vasculopathy (PCV) is a common subtype of exudative age-related macular degeneration among Asian individuals. To our knowledge, there are no large randomized clinical trials to evaluate intravitreal ranibizumab, with and without verteporfin photodynamic therapy (vPDT), for the treatment of PCV. Objective To compare the efficacy and safety of combination therapy of ranibizumab and vPDT with ranibizumab monotherapy in PCV. Design, Setting, and Participants A double-masked, multicenter randomized clinical trial of 322 Asian participants with symptomatic macular PCV confirmed by the Central Reading Center using indocyanine green angiography was conducted between August 7, 2013, and March 2, 2017. Interventions Participants were randomized 1:1 to ranibizumab, 0.5 mg, and vPDT (n = 168; combination therapy group) or ranibizumab, 0.5 mg, and sham PDT (n = 154; monotherapy group). All participants received 3 consecutive monthly ranibizumab injections, followed by a pro re nata regimen. Participants also received vPDT/sham PDT on day 1, followed by a pro re nata regimen based on the presence of active polypoidal lesions. Main Outcomes and Measures Step 1 assessed whether combination therapy was noninferior (5-letter margin) to monotherapy for change in best-corrected visual acuity from baseline and superior in complete polyp regression. If noninferiority was established, step 2 assessed whether combination therapy was superior to monotherapy measured by best-corrected visual acuity change at month 12. Results Baseline demographics of the 322 participants were comparable between the treatment groups. Mean (SD) age of the patients was 68.1 (8.8) years, and overall, 69.9% of the patients were men. At baseline, the overall mean best-corrected visual acuity and mean central subfield thickness were 61.1 letters and 413.3 μm, respectively. At 12 months, mean improvement from baseline was 8.3 letters with combination therapy vs 5.1 letters with monotherapy (mean difference, 3.2 letters; 95% CI, 0.4-6.1), indicating that combination therapy met the predefined criterion for noninferiority as well as being superior to monotherapy (P = .01). Combination therapy was also superior to monotherapy in achieving complete polyp regression at month 12 (69.3% vs 34.7%; P < .001). Over 12 months, the combination therapy group received a median of 4.0 ranibizumab injections compared with 7.0 in the monotherapy group. Vitreous hemorrhage was the only ocular serious adverse event (combination therapy group, 1 [0.6%]; monotherapy group, 3 [2.0%]). Conclusions and Relevance After 12 months, combination therapy of ranibizumab plus vPDT was not only noninferior but also superior to ranibizumab monotherapy in best-corrected visual acuity and superior in complete polyp regression while requiring fewer injections. Combination therapy should be considered for eyes with PCV. Trial Registration clinicaltrials.gov Identifier: NCT01846273.
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Affiliation(s)
- Adrian Koh
- Eye and Retina Surgeons, Camden Medical Centre, Singapore, Singapore
| | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Kanji Takahashi
- Department of Ophthalmology, Kansai Medical University, Hirakata Hospital, Osaka, Japan
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Lee-Jen Chen
- Department of Ophthalmology, Mackay Memorial Hospital, Taipei, Taiwan
| | | | - Colin S Tan
- Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | | | | | - Tock H Lim
- Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Won Ki Lee
- Department of Ophthalmology, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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Kokame GT, Shantha JG, Hirai K, Ayabe J. En Face Spectral-Domain Optical Coherence Tomography for the Diagnosis and Evaluation of Polypoidal Choroidal Vasculopathy. Ophthalmic Surg Lasers Imaging Retina 2017; 47:737-44. [PMID: 27548451 DOI: 10.3928/23258160-20160808-07] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/07/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the diagnostic capability of en face spectral-domain optical coherence tomography (SD-OCT) in patients with polypoidal choroidal vasculopathy (PCV) diagnosed by indocyanine green angiography (ICGA). PATIENTS AND METHODS A retrospective, consecutive case series of 100 eyes diagnosed with PCV by ICGA were imaged with en face SD-OCT. Evaluation of the PCV complex on en face SD-OCT was performed on the ability to diagnose PCV by the characteristic configuration of the PCV complex and the extent and size of the PCV lesion. RESULTS The PCV complex was better visualized on ICGA in 45 eyes, on en face SD-OCT in 44 eyes, and equally well in 11 eyes. The extent of the PCV complex was larger on en face SD-OCT in 65 eyes, larger on ICGA in 23 eyes, and equal in size in 12 eyes. CONCLUSION En face SD-OCT images the characteristic findings of PCV and provides a noninvasive way to diagnose and treat PCV when ICGA is not available. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:737-744.].
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Alasil T, Munoz N, Keane PA, Tufail A, Coady PA, Novais E, de Carlo TE, Baumal CR, Waheed NK, Duker JS, Adelman RA. Characteristics and racial variations of polypoidal choroidal vasculopathy in tertiary centers in the United States and United Kingdom. Int J Retina Vitreous 2017; 3:9. [PMID: 28428893 PMCID: PMC5392942 DOI: 10.1186/s40942-017-0060-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/17/2017] [Indexed: 01/01/2023] Open
Abstract
Purpose To evaluate the characteristics and racial variations amongst patients with polypoidal choroidal vasculopathy (PCV) in the United States and the United Kingdom. Methods Fundus photos and indocyanine green angiography images were evaluated in a multicenter retrospective study to establish the diagnosis of PCV. Visual acuity (VA) was recorded in ETDRS letter count. Results Eighty eyes of 71 PCV patients (average age of 69.4 ± 10.4 years) were included in the analysis. Of the total 71 subjects, 46 (65%) were women, 33 (46.5%) were Blacks, 16 (22.5%) were Whites, 19 (26.8%) were Asians and 3 (4.2%) belonged to other races. The Black subgroup had vision gain of 3.5 letters. The White and Asian subgroups had vision loss of 13.1 and 3.5 letters, respectively. There was female predominance in Blacks (67%), Whites (69%), and Asians (58%). PCV was found to be a bilateral disease in 14 patients (20%). There was significant decrease of 7 letters with every decade increase in age (p = 0.005). Final VA was worse in males when compared to females (p = 0.042), and worse in Whites when compared to Blacks (p = 0.005). For every 10 letters worse in initial VA upon diagnosis with PCV, the final VA was worse by 6 letters (p < 0.001). The location of the polypoidal lesion within the macula was associated with significant decrease of 14 letters in BCVA (p = 0.02). The length of follow up was significantly associated with worse visual outcome (p = 0.012). Final VA had no significant correlation with the lens status, or the different treatment modalities. Conclusions Based on our cohort from tertiary centers in the United States and United Kingdom, PCV is a bilateral disease in one-fifth of patients. It features a variable female predominance based on ethnicity. Increased age, worse vision upon initial presentation, longer follow up and macular location of the polyp were associated with worse visual outcome. Electronic supplementary material The online version of this article (doi:10.1186/s40942-017-0060-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tarek Alasil
- Department of Ophthalmology and Visual Sciences, School of Medicine, Yale University, New Haven, CT USA
| | - Nelida Munoz
- Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - Pearse A Keane
- Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - Adnan Tufail
- Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - Patrick A Coady
- Department of Ophthalmology and Visual Sciences, School of Medicine, Yale University, New Haven, CT USA
| | - Eduardo Novais
- New England Eye Center, Tufts Medical Center, Boston, MA USA.,School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | | | | | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, MA USA
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, MA USA
| | - Ron A Adelman
- Department of Ophthalmology and Visual Sciences, School of Medicine, Yale University, New Haven, CT USA
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90
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Yadav S, Parry DG, Beare NAV, Pearce IA. Polypoidal choroidal vasculopathy: a common type of neovascular age-related macular degeneration in Caucasians. Br J Ophthalmol 2017; 101:1377-1380. [PMID: 28270486 DOI: 10.1136/bjophthalmol-2016-310074] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/10/2017] [Accepted: 02/14/2017] [Indexed: 01/21/2023]
Abstract
AIMS To describe the prevalence of polypoidal choroidal vasculopathy (PCV) in a Caucasian population with neovascular age-related macular degeneration (NAMD). METHODS All patients referred to a city AMD service over a 2-year period underwent imaging including Indocyanine Green Angiography at baseline. A panel of experts confirmed the patients with NAMD and diagnosed the lesion type including PCV. The proportion of Caucasian patients with PCV was identified. Two authors independently reviewed clinical imaging and recorded data of patients with PCV on lesion characteristics. Further information including treatments received and visual acuity at different time points was analysed. RESULTS A total of 492 patients were diagnosed with NAMD during the 2-year study period. Of these patients, 204 had occult lesions (41.5%). PCV was identified in 45 patients (22.1% of occult NAMD and 9.1% of all NAMD). 23 patients received anti-vascular endothelial growth factor (VEGF) monotherapy, 8 received verteporfin photodynamic therapy (PDT) monotherapy and the remaining 14 patients were managed with combined PDT and anti-VEGF treatment. CONCLUSIONS The prevalence of PCV in Caucasians is higher than previously reported. Indocyanine Green Angiography should be a standard investigation for all new patients with NAMD, particularly those with occult NAMD, to avoid missing this important subset.
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Affiliation(s)
- Sohraab Yadav
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - David G Parry
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Nick A V Beare
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Ian A Pearce
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
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91
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Lin WY, Chou SF, Tsai CL, Chen SJ. Temporally Coherent Illumination Normalization for Indocyanine Green Video Angiography. IEEE J Biomed Health Inform 2017; 22:570-578. [PMID: 28092584 DOI: 10.1109/jbhi.2017.2652446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Indocyanine green (ICG) angiography is an imaging method for doctors to observe choroidal abnormalities in human eyes. The ICG angiograms typically exhibit inhomogeneous illumination, which poses serious difficulties for the development of computer-aided diagnostic tools. In this paper, we propose a novel illumination normalization method to alleviate the inhomogeneous illumination in ICG video angiograms. In particular, we first align the viewpoint of the input ICG video angiogram using an image registration method. Then, we acquire temporal information using time-dependent intrinsic image and compute the corresponding illumination image. Finally, we correct inhomogeneous illumination from the illumination image by estimating contrast and luminosity distortion. We have conducted extensive evaluation using ICG video angiograms of 60 patients. Two video quality assessment methods are utilized to evaluate the performance of our proposed illumination normalization method. The results show that our proposed method can help improve the visual quality of ICG video angiogram. Visual evaluation by a human expert also confirms that our method yields better illumination normalization results.
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92
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Takayama K, Ito Y, Kaneko H, Kataoka K, Sugita T, Maruko R, Hattori K, Ra E, Haga F, Terasaki H. Comparison of indocyanine green angiography and optical coherence tomographic angiography in polypoidal choroidal vasculopathy. Eye (Lond) 2017; 31:45-52. [PMID: 27813526 PMCID: PMC5233943 DOI: 10.1038/eye.2016.232] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/14/2016] [Indexed: 11/08/2022] Open
Abstract
PurposeTo compare optical coherence tomographic angiography (OCTA) and indocyanine green angiography (ICGA) images for detecting polypoidal lesions (PLs) and branching vascular networks (BVNs), and to measure the polypoidal areas (PAs) in patients with polypoidal choroidal vasculopathy (PCV).MethodsAll patients underwent ICGA, optical coherence tomography (OCT), and OCTA. We compared the detection sensitivity for PL and BVN, as evaluated by the ICGA and OCTA images. Furthermore, PA measured by ICGA was divided into two groups: one in which the area could be measured by OCTA (ICGA+OCTA+) and the other in which the area could not be measured by OCTA (ICGA+OCTA-).ResultsTwenty-one consecutive eyes of 21 patients (mean age, 73.8±9.8 years) were included. ICGA detected PL in all eyes (100%), whereas OCTA detected PL in 16 eyes (75.2%); ICGA detected BVN in 15 eyes (71.4%), whereas OCTA detected BVN in 20 eyes (95.2%). The mean PA in ICGA+OCTA+ and ICGA+OCTA- was 0.24±0.04 and 0.14±0.01 mm2, respectively; a significant difference was observed between ICGA+OCTA+ PA and ICGA+OCTA- PA (P<0.0001). In addition, the mean PA in the ICGA+OCTA+ group measured by ICGA and OCTA was 0.24±0.04 was 0.19±0.04 mm2, respectively; these values were significantly different (P=0.0046).ConclusionsOCTA might detect more BVNs and fewer PLs compared with ICGA, and PL detected by OCTA might be smaller than those detected by ICGA.
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Affiliation(s)
- K Takayama
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Y Ito
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - H Kaneko
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - K Kataoka
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - T Sugita
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - R Maruko
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - K Hattori
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - E Ra
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - F Haga
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - H Terasaki
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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93
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Tan CS, Sadda SR. The role of central reading centers--current practices and future directions. Indian J Ophthalmol 2016; 63:404-5. [PMID: 26139801 PMCID: PMC4501136 DOI: 10.4103/0301-4738.159866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Central reading centers (CRCs) have several crucial roles in the conduct of clinical trials, providing key input during the study design, preparation of the operations manual, as well as site and photographer certification. They provide objective, standardized grading of images from study subjects, which determines study eligibility, and also evaluate lesion features at subsequent study visits. CRCs need to adhere strictly to Good Clinical Practice (GCP) guidelines, as well as the established standard operating procedures in order to ensure that images are graded properly. The role of CRCs will continue to evolve, and include the use of web-based image transmission and grading platforms.
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Affiliation(s)
- Colin S Tan
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital; Fundus Image Reading Center, National Healthcare Group Eye Institute, Singapore
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94
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Analysis of the Serum Lipid Profile in Polypoidal Choroidal Vasculopathy. Sci Rep 2016; 6:38342. [PMID: 27910906 PMCID: PMC5133601 DOI: 10.1038/srep38342] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 11/09/2016] [Indexed: 01/20/2023] Open
Abstract
Polypoidal choroidal vasculopathy (PCV), the predominant subtype of neovascular age-related macular degeneration in the Asian population, is associated with genetic polymorphism of lipid metabolism. In this study, we performed the untargeted lipidomics approach of ultra-performance liquid chromatography coupled with mass spectrometry (UPLC-MS) to reveal the potential discriminating lipid profile of PCV patients in serum (21 PCV patients and 19 age-matched controls). Unsupervised principal component, supervised orthogonal partial least squares analysis, correlation analysis, and heatmap analysis were performed with the data obtained by UPLC-MS. Forty-one discriminating metabolites were identified. Receiver operating characteristic curve analysis, pathway analysis and functional analysis were performed subsequently, and platelet-activating factor (PAF) was further selected as the key indicator of the distinct lipid metabolism in PCV patients. Finally, the serum level of PAF was validated by enzyme-linked immunosorbent assay, which is significantly higher in PCV patients compared to controls (65 PCV patients and 63 age-matched controls, p < 0.0001), consistent with the UPLC-MS analysis. Our results suggested that PAF is considered as the major indicator of the distinct lipid metabolism in PCV patients.
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95
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Tan CS, Hariprasad SM, Lim LW, Sadda SR. Evaluation of the Retinal and Choroidal Vasculature With OCT Angiography Versus Conventional Angiography. Ophthalmic Surg Lasers Imaging Retina 2016; 47:1081-1085. [PMID: 27977830 DOI: 10.3928/23258160-20161130-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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96
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Tan CS, Lim LW, Ngo WK. Treatment of massive subretinal hemorrhage from polypoidal choroidal vasculopathy and age-related macular degeneration. Int Ophthalmol 2016; 37:779-780. [PMID: 27671495 DOI: 10.1007/s10792-016-0351-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 09/08/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Colin S Tan
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore. .,Fundus Image Reading Center, National Healthcare Group Eye Institute, Singapore, Singapore.
| | - Louis W Lim
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Wei Kiong Ngo
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
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97
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Cho JH, Ryoo NK, Cho KH, Park SJ, Park KH, Woo SJ. Incidence Rate of Massive Submacular Hemorrhage and its Risk Factors in Polypoidal Choroidal Vasculopathy. Am J Ophthalmol 2016; 169:79-88. [PMID: 27318076 DOI: 10.1016/j.ajo.2016.06.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/04/2016] [Accepted: 06/06/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the incidence rate of massive submacular hemorrhage (SMH) in patients with polypoidal choroidal vasculopathy (PCV) and analyze the associated risk factors. DESIGN Retrospective cohort study. METHODS Patients diagnosed with PCV from May 2003 to May 2014 were included. Two hundred forty-five eyes of 245 patients were enrolled. The time between the initial visit to the clinic with subjective visual symptoms and the date of massive SMH was recorded. SMH larger than 4 disc diameters was defined as massive SMH. Age; hypertension; visual acuity (VA); indocyanine green angiography findings, including the greatest linear dimension, largest polyp size, and PCV type (cluster vs non-cluster); and treatment methods were reviewed for risk factor analysis using Kaplan-Meier survival and Cox regression analyses. RESULTS The incidence rate of massive SMH within 1 year after the initial visit was 2.45%. Massive SMH occurred within 3, 5, and 10 years after the first visit in 6.17%, 11.09%, and 29.85% of patients, respectively. Cox regression analysis revealed that the cluster type of PCV was significantly associated with massive SMH (hazard ratio [HR], 3.418; P = .003). Photodynamic therapy followed by anti-vascular endothelial growth factor injection lowered the risk of massive SMH (HR = .242; P = .047]. Final VA in eyes with massive SMH was significantly lower than that in patients without massive SMH (1.34 ± 0.66 vs 0.63 ± 0.53 logMAR; P < .001). CONCLUSIONS Patients with PCV who develop massive SMH experience severe vision loss. The incidence rate of massive SMH in PCV increases with time. The cluster type of polyp in PCV is a significant risk factor for massive SMH.
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98
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Tan CS, Ngo WK, Lim LW, Tan NW, Lim TH. EVEREST study report 3: diagnostic challenges of polypoidal choroidal vasculopathy. Lessons learnt from screening failures in the EVEREST study. Graefes Arch Clin Exp Ophthalmol 2016; 254:1923-1930. [PMID: 27142805 PMCID: PMC5045476 DOI: 10.1007/s00417-016-3333-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 02/26/2016] [Accepted: 03/28/2016] [Indexed: 12/02/2022] Open
Abstract
Purpose To describe screening failures in the EVEREST study by examining the imaging characteristics that enabled differentiation of polypoidal choroidal vasculopathy (PCV) from cases that were subsequently diagnosed not to be PCV. Methods Post-hoc analysis of 34 patients with PCV reported as screening failures from EVEREST study. Standardised confocal scanning laser indocyanine green angiography (ICGA) images were graded by the Central Reading Centre to confirm PCV diagnosis based on the presence of early focal sub-retinal hyperfluorescence on ICGA and at least one of the following six diagnostic criteria: (1) nodular appearance of polyp(s) on stereoscopic examination, (2) hypofluorescent halo around nodule(s), (3) presence of a branching vascular network, (4) pulsation of polyp(s) on dynamic ICGA, (5) orange sub-retinal nodules on colour fundus photography, or (6) massive sub-macular haemorrhage (≥4 disc areas in size). Additional detailed image grading was performed with stereo-imaging and dynamic early-phase ICGA. Results Of the 95 screened PCV cases, 34 were excluded: (1) cases not suitable for recruitment as per the study protocol (n = 14), (2) equivocal lesions on ICGA characterised by small hyperfluorescent dots (n = 9), and (3) cases that were definitely not PCV (non-PCV, n = 11), identified by definitive diagnoses which included one case each of micro-aneurysm, retinal angiomatous proliferation, retino-choroidal anastomosis, small type-2 choroidal neovascularisation, retinal pigment epithelial (RPE) window defect and disciform scar; two cases of lesions where the choroidal vessel changed its course; and three cases of late-onset RPE staining. Conclusions Standardised image grading techniques used in EVEREST study enabled effective differentiation of non-PCV from actual PCV. Electronic supplementary material The online version of this article (doi:10.1007/s00417-016-3333-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Colin S Tan
- Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore, Singapore.
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Wei Kiong Ngo
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Louis W Lim
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Nikolle W Tan
- Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore, Singapore
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Tock H Lim
- Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore, Singapore
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
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99
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Tan CS, Ngo WK, Lim LW, Lim TH. Genetic influence on visual outcomes of polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 2016; 254:1019-20. [DOI: 10.1007/s00417-015-3161-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 08/21/2015] [Indexed: 10/23/2022] Open
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100
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Comparability of retinal thickness measurements using different scanning protocols on spectral-domain optical coherence tomography. Int Ophthalmol 2016; 36:791-797. [PMID: 26887565 DOI: 10.1007/s10792-016-0197-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 02/05/2016] [Indexed: 10/22/2022]
Abstract
Retinal thickness measurements obtained using optical coherence tomography (OCT) play an essential role both in multi-center clinical trials and in normal clinical practice. Different scanning protocols are available on most OCT devices, and it is important to ascertain whether the retinal thickness measurements obtained from these are comparable. This study aimed to compare retinal thickness measurements between raster and radial scanning protocols using spectral-domain OCT (SD-OCT). In a prospective study, 32 healthy subjects were scanned sequentially using raster and radial protocols from a SD-OCT device. For both the raster and radial OCT scans, retinal thicknesses were measured manually subfoveally and at 12 other points at 0.5 mm intervals temporally and nasally on the horizontal OCT B-scan passing through the fovea. The retinal thickness measurements were compared using intraclass correlation (ICC) and Bland-Altman plots. Subfoveal retinal thickness was 227.0 µm when measured on the raster scan and 229.2 µm on the radial scan, with a mean difference of 2.2 µm (P = 0.141).The ICC for agreement was 0.889 (95 % confidence interval 0.818-0.933). Similar results were observed for retinal thickness measurements at all other points, with mean differences ranging from -3.37 to 2.59 µm, and ICC values ranging from 0.837 to 0.972. The retinal thickness measurements obtained by the raster and radial scans of the same SD-OCT device are comparable, with differences of less than 4 µm. This is of relevance when measurements made using different OCT scan protocols are compared.
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