1
|
Jung H, Suh Y, Lee J, Lee CS, Kim M, Byeon SH, Kim SS, Kang HG. Pachychoroid Spectrum Disease: Comparison of Patients with Central Serous Chorioretinopathy Complicated with Pachychoroid Neovasculopathy. KOREAN JOURNAL OF OPHTHALMOLOGY 2024; 38:304-315. [PMID: 39013560 PMCID: PMC11321835 DOI: 10.3341/kjo.2024.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/29/2024] [Accepted: 07/13/2024] [Indexed: 07/18/2024] Open
Abstract
PURPOSE This study aimed to determine the incidence and visual outcomes of pachychoroid neovasculopathy (PNV) in patients initially diagnosed with central serous chorioretinopathy (CSC). METHODS In this study, 144 patients aged 20 to 55 years with treatment-naive chronic CSC, defined as the persistence of subretinal fluid (SRF) for ≥6 months, were retrospectively enrolled. Patients with PNV at the initial evaluation were categorized as group 1, whereas those who developed new-onset PNV during follow-up were categorized as group 2. Patients without PNV until the end of the follow-up were categorized as group 3. RESULTS Over a mean follow-up period of 49.9 ± 39.9 months, new-onset PNV was diagnosed in 11.8% of patients with CSC. The time taken to reach the initial resolution was longest in group 1 (group 1, 11.13 ± 10.70 months; group 2, 8.14 ± 7.90 months; group 3, 7.32 ± 9.55 months), although these differences were not statistically significant. The numbers of injections needed to achieve initial resolution were 3.76 ± 5.90, 1.64 ± 2.06, and 1.74 ± 4.33 in groups 1, 2, and 3, respectively, with no significant differences. SRF recurrence was recorded in seven patients (29.2%) in group 1, nine (64.3%) in group 2, and 28 (26.7%) in group 3. The recurrence rates were significantly higher in group 2 than those in group 1 or 3. At the end of the follow-up period, significant improvements in best-corrected visual acuity were achieved in groups 1 and 3, compared with baseline, but not in group 2. CONCLUSIONS Patients with chronic CSC with new-onset PNV exhibited higher SRF recurrence and worse visual outcomes compared to those with initial PNV or those with chronic CSC without PNV. Our study emphasizes the importance of routine screening for prompt diagnoses of new-onset PNV in individuals with chronic CSC.
Collapse
Affiliation(s)
- Hyunjean Jung
- Institute of Vision Research, Department of Ophthalmology, Severance Eye Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Youngsong Suh
- Institute of Vision Research, Department of Ophthalmology, Severance Eye Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Junwon Lee
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Christopher Seungkyu Lee
- Institute of Vision Research, Department of Ophthalmology, Severance Eye Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Min Kim
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Suk Ho Byeon
- Institute of Vision Research, Department of Ophthalmology, Severance Eye Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Sung Soo Kim
- Institute of Vision Research, Department of Ophthalmology, Severance Eye Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Hyun Goo Kang
- Institute of Vision Research, Department of Ophthalmology, Severance Eye Hospital, Yonsei University College of Medicine, Seoul,
Korea
| |
Collapse
|
2
|
Lange CA, Ohlmeier C, Kiskämper A, von Schwarzkopf C, Hufnagel H, Gruber M, Schworm B, Brocks U, Reinking F, Schreiner L, Miura Y, Grundel M, Lohmann T, Clemens CR, Gamulescu MA, Eter N, Grisanti S, Priglinger S, Spitzer MS, Walter P, Agostini HA, Stahl A, Pauleikhoff LJ. Clinical Landscape of Central Serous Chorioretinopathy in Germany: Retina.net CSC Registry Report Number 1. Ophthalmologica 2024; 247:95-106. [PMID: 38368867 PMCID: PMC11160426 DOI: 10.1159/000535930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/11/2023] [Indexed: 02/20/2024]
Abstract
INTRODUCTION The German Registry of central serous chorioretinopathy (CSC) collects data on CSC patients in a nationwide multicenter approach to analyze epidemiology, risk factors, clinical presentations, as well as diagnosis and treatment patterns. METHODS In this multicenter cohort study, patients with CSC were enrolled in nine tertiary referral centers in Germany between January 2022 and June 2023. After consenting to the study, demographic data, risk factors, reported symptoms, best-corrected visual acuity (BCVA), funduscopic findings, disease severity, and diagnostic and treatment decisions were recorded and analyzed. RESULTS A total of 539 eyes of 411 CSC patients were enrolled in this study including 308 males (75%) and 103 females (25%). Patients were predominantly of Caucasian origin and had a mean age of 55.5 years (IQR 41.0-70.0). 28% of eyes were classified as acute (<4 months duration) CSC, 28% as chronic (>4 months duration) CSC, 21% as inactive CSC, 11% as chronic atrophic CSC, and 12% as CSC with secondary CNV. 128 patients (31%) demonstrated bilateral CSC. The most common risk factors reported were psychological stress (52%), smoking (38%), arterial hypertension (38%), and a history of or current use of steroids (30%). Most frequently encountered symptoms included decreased visual acuity (76%), metamorphopsia (49%), relative scotoma (47%), blurred vision (19%), and dyschromatopsia (9%). The mean logMAR BCVA on initial examination was 0.2 (≈20/30, IQR 0.2-0.4) but showed significant variation with a tendency of lower BCVA in chronic cases. At the baseline visit, 74% of the overall cohort received no treatment, while 19% underwent local treatment and only 2% underwent systemic treatment. Of the local therapies, anti-VEGF injections were the most frequently performed procedure (33%, mainly for secondary CNV), followed by micropulse laser (28%), focal nonpulsed laser (23%), verteporfin photodynamic therapy (14%), and nonsteroidal anti-inflammatory eye drops (2%). Among intravitreal anti-VEGF agents, aflibercept was used most frequently, followed by bevacizumab and ranibizumab. CONCLUSION This registry represents one of the largest cohorts of European patients with CSC to date. Patient age and the proportion of women were higher than expected and bilateral active disease was lower than anticipated, highlighting that neither age nor gender should be overemphasized when diagnosing CSC. Therapeutic interventions are heterogeneous and include verteporfin photodynamic therapy, micropulse laser, and anti-VEGF injections in case of secondary CNV.
Collapse
Affiliation(s)
- Clemens A. Lange
- Department of Ophthalmology, St. Franziskus Hospital, Münster, Germany
- Eye Center, Freiburg Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
| | | | - Anna Kiskämper
- Department of Ophthalmology, St. Franziskus Hospital, Münster, Germany
| | | | - Hinrich Hufnagel
- Eye Center, Freiburg Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Markus Gruber
- Eye Center, Freiburg Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Benedikt Schworm
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ulrike Brocks
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Reinking
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Lisa Schreiner
- Department of Ophthalmology, University Hospital of Regensburg, Regensburg, Germany
| | - Yoko Miura
- Department of Ophthalmology, University of Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Milena Grundel
- Department of Ophthalmology Greifswald, University Medicine Greifswald, Greifswald, Germany
| | - Tibor Lohmann
- Department of Ophthalmology, RWTH University Hospital of Aachen, Aachen, Germany
| | - Christoph R. Clemens
- Department of Ophthalmology, University of Münster Medical Center, Münster, Germany
| | | | - Nicole Eter
- Department of Ophthalmology, RWTH University Hospital of Aachen, Aachen, Germany
| | - Salvatore Grisanti
- Department of Ophthalmology, University of Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Siegfried Priglinger
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Martin S. Spitzer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Walter
- Department of Ophthalmology, RWTH University Hospital of Aachen, Aachen, Germany
| | - Hansjürgen A. Agostini
- Eye Center, Freiburg Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Andreas Stahl
- Department of Ophthalmology Greifswald, University Medicine Greifswald, Greifswald, Germany
| | - Laurenz J.B. Pauleikhoff
- Eye Center, Freiburg Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - for the Retina.net CSC-Registry-Study Group
- Department of Ophthalmology, St. Franziskus Hospital, Münster, Germany
- Eye Center, Freiburg Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
- Macula Monitor Münster (M3), St. Franziskus Hospital, Münster, Germany
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, Germany
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Ophthalmology, University Hospital of Regensburg, Regensburg, Germany
- Department of Ophthalmology, University of Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
- Department of Ophthalmology Greifswald, University Medicine Greifswald, Greifswald, Germany
- Department of Ophthalmology, RWTH University Hospital of Aachen, Aachen, Germany
- Department of Ophthalmology, University of Münster Medical Center, Münster, Germany
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| |
Collapse
|
3
|
Xia F, Xing P, Zhang H, Niu T, Wang Q, Hua R. Factors Influencing Visual Acuity in Patients with Active Subfoveal Circumscribed Polypoidal Choroidal Vasculopathy and Changes in Imaging Parameters. Diagnostics (Basel) 2023; 13:3017. [PMID: 37761384 PMCID: PMC10529091 DOI: 10.3390/diagnostics13183017] [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: 07/26/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
We performed a retrospective, observational study of 51 eyes in 51 treatment-naïve patients with polypoidal choroidal vasculopathy (PCV), whose lesion ranged within the 6 × 6 mm scope of optical coherence tomography angiography (OCTA). The patients were divided into an ill-defined group and a well-defined group based on the pattern of branching vascular network (BVN) on OCTA. BVN morphology was not related to baseline best-corrected visual acuity (BCVA). However, the BCVA in the ill-defined BVN group (-0.18 [interquartile range: -0.40 to 0.00]) was significantly improved after anti-vascular endothelial growth factor (VEGF) injections, compared with that (0.00 [interquartile range: -0.18 to 0.00]) in the well-defined group (z = 2.143, p = 0.032). Multiple logistic regression analysis showed that male sex, fewer injections, and the presence of polypoidal lesions on OCTA images at baseline predicted a poor prognosis in patients with polypoidal lesions on OCTA images after anti-VEGF therapy (all p < 0.05). Finally, BCVA at baseline and the number of injections were protective factors for BCVA after anti-VEGF therapy (all p < 0.05). In contrast, a history of hypertension and macular edema at baseline were risk factors for BCVA after anti-VEGF injections (all p < 0.05). Our results revealed the visual and morphological prognosis of patients with active subfoveal circumscribed PCV after anti-VEGF therapy.
Collapse
Affiliation(s)
- Fan Xia
- Department of Ophthalmology, The Fourth People’s Hospital of Shenyang, China Medical University, Shenyang 110001, China; (F.X.); (P.X.); (H.Z.); (T.N.); (Q.W.)
| | - Peiyu Xing
- Department of Ophthalmology, The Fourth People’s Hospital of Shenyang, China Medical University, Shenyang 110001, China; (F.X.); (P.X.); (H.Z.); (T.N.); (Q.W.)
| | - Hao Zhang
- Department of Ophthalmology, The Fourth People’s Hospital of Shenyang, China Medical University, Shenyang 110001, China; (F.X.); (P.X.); (H.Z.); (T.N.); (Q.W.)
| | - Tongtong Niu
- Department of Ophthalmology, The Fourth People’s Hospital of Shenyang, China Medical University, Shenyang 110001, China; (F.X.); (P.X.); (H.Z.); (T.N.); (Q.W.)
| | - Qi Wang
- Department of Ophthalmology, The Fourth People’s Hospital of Shenyang, China Medical University, Shenyang 110001, China; (F.X.); (P.X.); (H.Z.); (T.N.); (Q.W.)
| | - Rui Hua
- Department of Ophthalmology, First Hospital of China Medical University, Shenyang 110001, China
| |
Collapse
|
4
|
Montero Hernández J, Remolí Sargues L, Monferrer Adsuara C, Castro Navarro V, Navarro Palop C, Cervera Taulet E. Two-Year Results of a Treat and Extend Regimen with Aflibercept in Caucasian Patients with Pachychoroid Neovasculopathy. Semin Ophthalmol 2023; 38:352-357. [PMID: 36987548 DOI: 10.1080/08820538.2023.2194983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/08/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION There are few reports evaluating the treatment of pachychoroid neovasculopathy (PNV) in white patients. The purpose of this study is to analyze the results of a treat and extend regimen with aflibercept in white patients with PNV after 2 years of follow-up. METHODS We performed a retrospective study in 31 eyes of 26 patients with PNV treated with a treat an extend regimen of intravitreal aflibercept. The mean age was 63,84 ± 7.92 years. There were 9 males (35%) and 17 females (65%). Best-corrected visual acuity (BCVA), central macular thickness (CMT), choroidal subfoveal thickness (CST), choroidal thickness (CT) under type 1 choroidal neovascularization (CNV), pigment epithelium detachment (PED) height, and presence of subretinal fluid (SRF), intraretinal fluid (IRF) and wet macula, were evaluated at baseline and after 3, 6, 12, and 24 months. RESULTS BCVA remained stable during the follow-up (p 0.161). A significant diminution of CMT was found (p 0.001). Conversely, PED height diminution was not significative (p 0.260). CST and CT under type 1 CNV improved significantly during the follow-up (p 0.005 and 0.009, respectively). Also, wet macula improved after 24 months (p < .001). The average number of intravitreal injections was 12.34 ± 6.01. CONCLUSION Treat and extend regimen with intravitreal aflibercept in white patients with PNV may be effective for improving CMT, CST, CT under type 1 CNV and wet macula, and to stabilize vision, with a personalized regimen of intravitreal injections.
Collapse
Affiliation(s)
- Javier Montero Hernández
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Lidia Remolí Sargues
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Clara Monferrer Adsuara
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Verónica Castro Navarro
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Catalina Navarro Palop
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Enrique Cervera Taulet
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| |
Collapse
|
5
|
Yamashiro K, Yanagi Y, Koizumi H, Matsumoto H, Cheung CMG, Gomi F, Iida T, Tsujikawa A. Relationship between Pachychoroid and Polypoidal Choroidal Vasculopathy. J Clin Med 2022; 11:jcm11154614. [PMID: 35956229 PMCID: PMC9369798 DOI: 10.3390/jcm11154614] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/14/2022] [Accepted: 08/05/2022] [Indexed: 11/20/2022] Open
Abstract
Previous clinical studies have suggested that pachychoroid can induce macular neovascularization (MNV) to develop pachychoroid neovasculopathy (PNV) and that PNV can progress to polypoidal choroidal vasculopathy (PCV). Recent studies based on the pachychoroid concept are now gradually revealing the true nature of, at least some part of, PCV. However, previous studies on PNV and/or PCV have used different frameworks for the classification of PNV, PCV, and neovascular age-related macular degeneration (nAMD). These have hampered the rapid overhaul of the understanding of PCV. Some investigators have assumed that all PCV is pachychoroid-driven whereas other investigators have classified PCV into “pachychoroid PCV” and “non-pachychoroid PCV”. Furthermore, since there is no consensus as to whether PNV includes PCV, some studies have included PCV with PNV, while other studies have excluded PCV from PNV. To address these gaps, we summarize previous studies on PCV and pachychoroid. Even before the proposal of the pachychoroid concept, previous studies had suggested that PCV could be divided into two subtypes, of which one was characterized by pachychoroid features. Previous studies had also provided keys to understand relationship between PCV and PNV. We here recommend a refined conceptual framework for future studies on PNV, PCV, and nAMD. Considering the current inconsistent understanding of PCV, we should be cautious about using the term PCV until we understand the true nature of PCV.
Collapse
Affiliation(s)
- Kenji Yamashiro
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Nankoku 7838505, Japan
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto 6068507, Japan
- Correspondence: ; Tel.: +81-88-880-2391
| | - Yasuo Yanagi
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama 2320024, Japan
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 168751, Singapore
- The Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
| | - Hideki Koizumi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Nishihara 9030215, Japan
| | - Hidetaka Matsumoto
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi 3718511, Japan
| | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 168751, Singapore
- The Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
| | - Fumi Gomi
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya 6638501, Japan
| | - Tomohiro Iida
- Department of Ophthalmology, Tokyo Women’s Medical University, Tokyo 1628666, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto 6068507, Japan
| |
Collapse
|
6
|
Karasu B, Akbas YB, Kaskal M, Aykut A, Celebi ARC. Long term results of three anti-vascular endothelial growth factor agents in pachychoroid neovasculopathy. Cutan Ocul Toxicol 2022; 41:145-154. [PMID: 35579866 DOI: 10.1080/15569527.2022.2068150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To assess morphological changes and visual results in eyes with pachychoroid neovasculopathy (PNV) that underwent different intravitreal anti-vascular endothelial growth factor (VEGF) agents. MATERIALS AND METHODS This is a retrospective, observational, comparative study included 76 PNV eyes in 76 patients that were allocated to 3 groups according to monotherapy injection procedure, as follows: the intravitreal bevacizumab (IVB) group, intravitreal ranibizumab (IVR) group, and intravitreal aflibercept (IVA) group. Central macular thickness (CMT), best-corrected visual acuity (BCVA), and subfoveal choroidal thickness (SFCT) were measured at baseline, after treatment 1st month, 3rd month, 6th month, and 12th month, and at the final post-treatment examination. RESULTS Mean age of the patients was 57.31 ± 5.91 years (range: 34-67 years). Mean duration of follow-up was 31.50 ± 12.91 months (range: 13-60 months). The IVB group included 30 eyes, the IVR group included 22 eyes, and the IVA group included 24 eyes. There weren't any significant differences in BCVA changes between the groups at any post-baseline measurement time point. Although CMT did not change significantly in the IVB group from baseline to final follow-up visit (baseline: 376.33 ± 86.31µm; final visit: 340.80 ± 122.70 µm) (p = 0.172), CMT did change significantly in the IVA group (baseline: 383.41 ± 131.83 µm; final visit: 297.33 ± 103.81 µm) (p = 0.029) and IVR group (baseline: 379.18 ± 97.93 µm; final visit: 335.72 ± 111.45 µm) (p = 0.041). SFCT decreased significantly in the IVR and IVA groups (p = 0.015 and p < 0.001, respectively). The mean number of injections was 12.06 ± 4.72 (range: 6-20) in the IVB group, 11.81 ± 3.31(range: 7-17) in the IVR group, and 7.16 ± 3.15 (range: 4-13) in the IVA group (p = 0.004). CONCLUSION All 3 anti-VEGFs were effective in terms of visual results in patients with PNV. Patients treated with IVA required fewer injections than those treated with IVB or IVR. Furthermore, IVR and IVA treatment significantly decreased SFCT, whereas IVB did not.
Collapse
Affiliation(s)
- Buğra Karasu
- Tuzla State Hospital, Department of Ophthalmology, Istanbul, Turkey.,University of Health Sciences, Beyoglu Eye Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Yusuf Berk Akbas
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Mert Kaskal
- Marmara University School of Medicine, Department of Medical Pharmacology, Istanbul, Turkey
| | - Aslan Aykut
- Marmara University, School of Medicine, Department of Ophthalmology, Istanbul, Turkey
| | - Ali Rıza Cenk Celebi
- Acibadem University, School of Medicine, Department of Ophthalmology, Istanbul, Turkey
| |
Collapse
|
7
|
Progression of pachychoroid neovasculopathy into aneurysmal type 1 choroidal neovascularization or polypoidal choroidal vasculopathy. Ophthalmol Retina 2022; 6:807-813. [PMID: 35398547 DOI: 10.1016/j.oret.2022.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To describe the progression of pachychoroid neovasculopathy (PNV) into pachychoroid aneurysmal type 1 choroidal neovascularization (PAT1) / polypoidal choroidal vasculopathy (PCV). DESIGN Retrospective longitudinal cohort study. SUBJECTS Patients diagnosed with PNV with a follow-up of ≥ 2 years. METHODS Multimodal imaging, including optical coherence tomography and fluorescein and indocyanine green angiography, was reviewed for the presence of choroidal neovascularization (CNV), aneurysms within/at the margins of the CNV and sub-foveal choroidal thickness (SFCT). MAIN OUTCOME MEASURES Rate of PNV to PAT1/PCV conversion and risk factors thereof. RESULTS In total, 37 PNV eyes of 32 patients with a mean follow-up of 3.3±1.1 (2.0 - 5.2) years were included in the study. At PNV diagnosis, mean age was 59.7±8.7 (range: 38.5 - 78.0) years and mean SFCT was 357±92 (185 - 589) μm. During follow-up, 5 eyes (13.5 %) developed aneurysms after a mean 3.4±0.8 years (2.3 - 4.2 years) years, defining PAT1/PCV. Risk of PAT1/PCV conversion was 7.4 % at year 3, 13.6 % at year 4 and 30.7 % at year 5. Mean 5.2±4.0 to 8.1±3.4 intravitreal anti-VEGF injections were given per year, resulting in a significant reduction of SFCT to 317±104 (122 to 589) μm (p= 0.0007). Age at diagnosis of PNV was significantly lower in eyes that later went on to develop PAT1/PCV (54.0±5.6 (45.9 to 60.5) vs. 61.2±8.4 (38.5 - 78.0) years, p=0.025). At end of follow-up, SFCT had on average decreased by -14.0±17.6 (-55.9 to 23.1) % in the PNV group, while it had increased by mean 6.9±4.4 (0.00 to 10.8) % in the PAT1/PCV conversion group (p=0.0025). CONCLUSION PNV can develop aneurysms within its type 1 CNV, defining conversion to PAT1/PCV. In this study, conversion to PAT1/PCV was seen in 13.5 % of eyes, resulting in Kaplan Meier estimates of risk for conversion of 7.4 % at year 3, 13.6 % at year 4 and 30.7 % at year 5. Younger age at diagnosis of PNV and sustained choroidal thickening despite anti-VEGF therapy might be risk factors for PNV to progress into PAT1/PCV.
Collapse
|
8
|
Hua R, Duan J, Zhang M. Pachychoroid Spectrum Disease: Underlying Pathology, Classification, and Phenotypes. Curr Eye Res 2021; 46:1437-1448. [PMID: 34114902 DOI: 10.1080/02713683.2021.1942073] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Pachychoroid spectrum disease encompasses a set of macular disorders secondary to an abnormally thick choroid. However, the pathological process underlying pachychoroid spectrum disease and its overlap with age-related macular degeneration (AMD) remain unclear. This review aimed to understand the underlying pathology, classification, and phenotypes of pachychoroid spectrum disease. METHODS This comprehensive literature review was performed based on a search of peer-reviewed published papers relevant to the current knowledge of pachychoroid disease spectrum. RESULTS Pachychoroid is primarily a bilateral phenomenon; the main pathological lesions include choriocapillaris attenuation and abnormally dilated pachyvessels. Chronic central serous chorioretinopathy (CSC) and pachychoroid neovasculopathy (PNV) show similar morphological changes and angiogenic cytokine levels. The subretinal fluid in PNV may not accurately indicate PNV activity. Besides, types 1 and 2 of choroidal neovascularization (CNV) may be involved in primary pachychoroidal disease. Both choroidal arteriosclerosis and higher hydrostatic pressure contribute to hyalinized choroidal arteries and aneurysmal dilatations, resulting in PNV progression to polypoidal choroidal vasculopathy (PCV). Thus, pachychoroid-related type 2 CNV and chronic CSC could be considered as PNV (IIIc) and as a precursor of PNV (IIIa), respectively. Tangled PCV on optical coherence tomography angiography that fails to develop aneurysms should be classified as a subtype of PNV or a forme fruste of PCV. CONCLUSIONS Multiple disorders of the pachychoroid spectrum are considered as a continuous disease process, ultimately stimulated by choroidal malfunction. PCV overlaps both AMD and pachychoroid disease, especially for thin-choroid and bilateral types. The terminology and classification of pachychoroid spectrum disease should be used cautiously.
Collapse
Affiliation(s)
- Rui Hua
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Department of Ophthalmology, First Hospital of China Medical University, Shenyang, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Jianan Duan
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Meixia Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
9
|
Sagar P, Sodhi PS, Roy S, Takkar B, Azad SV. Pachychoroid neovasculopathy: A comparative review on pathology, clinical features, and therapy. Eur J Ophthalmol 2021; 32:11206721211036290. [PMID: 34325545 DOI: 10.1177/11206721211036290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There have been major changes in our understanding of choroidal diseases in the last decade owing to multiple retinal and choroidal imaging related advances. A major conceptual pivot is establishment of pachychoroid and its spectrum of clinical disorders: pachychoroid pigment epitheliopathy, central serous chorioretinopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy/aneurysmal type 1 neovascularization, peripapillary pachychoroid syndrome, and focal choroidal excavation. However, considerable overlaps in manifestations and therapeutics of these disorders make differentiation amongst them difficult. This review is focused on pathogenesis and clinical aspects of pachychoroid neovasculopathy (PNV). Since PNV was defined as a separate entity around 5 years ago, there have been numerous contrasting observations surrounding it. We review and summarize these studies, and also compare PNV with other disorders of the pachychoroid spectrum in detail. There are important differences between etiologies of neovascular age related macular degeneration and PNV. Yet the current treatment strategies for PNV have been extrapolated from the trials for the former. Future research needs to validate this assumption with long-term results.
Collapse
Affiliation(s)
- Pradeep Sagar
- Department of Vitreo-Retina, Sankara Eye Hospital, Shivamogga, India
| | | | - Sangeeta Roy
- Department of Vitreo Retina, Susrut Eye Foundation and Research Centre, Kolkata, West Bengal, India
| | - Brijesh Takkar
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
- Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, Hyderabad, Telangana, India
| | - Shorya Vardhan Azad
- Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
10
|
Abdin AD, Suffo S, Fries FN, Kaymak H, Seitz B. [Uniform classification of the pachychoroid spectrum disorders]. Ophthalmologe 2021; 118:865-878. [PMID: 33900429 DOI: 10.1007/s00347-021-01379-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 11/28/2022]
Abstract
Pachychoroid spectrum disorders are characterized by a thickening of the choroid. The spectrum includes pachychoroid pigment epitheliopathy (PPE), central serous chorioretinopathy (CCS), pachychoroid neovasculopathy (PNV), polypoidal choroidal vasculopathy (PCV)/aneurysmal type 1 choroidal neovascularization (ACNV-1), focal choroidal excavation (FCE) and peripapillary pachychoroid syndrome (PPS). If the choroid is thickened and there is a pathological alteration in the retinal pigment epithelium, the diagnosis is PPE; if the thickened choroid is accompanied by subretinal fluid, the diagnosis is CCS; if choroidal neovascularization is present, the diagnosis is PNV; if accompanied by aneurysms, the diagnosis is ACNV‑1. The PPE, CCS, PNV and ACNV‑1 were formerly regarded as independent disease entities but can be classified into four forms of a single disease family, pachychoroid macular disease.
Collapse
Affiliation(s)
- Alaa Din Abdin
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland.
| | - Shady Suffo
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| | - Fabian N Fries
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| | - Hakan Kaymak
- Internationale Innovative Ophthalmochirurgie (I. I. O.), 40549, Düsseldorf, Deutschland
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| |
Collapse
|
11
|
Miki A, Kusuhara S, Otsuji T, Kawashima Y, Miki K, Imai H, Nakamura M, Tsujikawa A. Photodynamic therapy combined with anti-vascular endothelial growth factor therapy for pachychoroid neovasculopathy. PLoS One 2021; 16:e0248760. [PMID: 33755678 PMCID: PMC7987186 DOI: 10.1371/journal.pone.0248760] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/04/2021] [Indexed: 11/19/2022] Open
Abstract
This multicenter retrospective study was conducted to evaluate the 1-year treatment outcome of photodynamic therapy (PDT) combined with anti-vascular endothelial growth factor (VEGF) therapy for pachychoroid neovasculopathy (PNV). A total of 42 eyes of 42 patients with treatment-naïve PNV who were treated with PDT combined with intravitreal injections of an anti-VEGF agent (ranibizumab or aflibercept) for 1 year. All eyes showed exudative and/or hemorrhagic changes that affected the fovea at baseline. After the initial combination therapy, subfoveal choroidal thickness (SCT) and central retinal thickness (CRT) were significantly reduced and were maintained as such for 12 months (P < 0.01 in SCT and CRT). The best-corrected visual acuity (BCVA) (0.19 ± 0.30 at baseline) significantly improved at 3 months (0.15 ± 0.29, P < 0.05) and further improved at 12 months (0.10 ± 0.30, P < 0.01) when compared to that at baseline. After the initial combination therapy, 32 eyes (76.2%) required no additional treatments for 12 months. The mean number of additional PDT and intravitreal injections of anti-VEGF agents was 0.1 ± 0.3 and 0.9 ± 1.9, respectively. Of the 42 eyes included in this study, 22 eyes (52.4%) had polypoidal lesions at baseline. No significant differences in SCT, CRT, or BCVA were observed at any time points between eyes with and without polypoidal lesions. Of 20 eyes without polypoidal lesions, only 1 eye (5.0%) needed additional treatments. PNV, especially without polypoidal lesions, can be treated effectively with PDT combined with anti-VEGF therapy with few sessions.
Collapse
Affiliation(s)
- Akiko Miki
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- * E-mail:
| | - Sentaro Kusuhara
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tsuyoshi Otsuji
- Department of Ophthalmology, Kansai Medical University Medical Center, Osaka, Japan
| | - Yu Kawashima
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Katsuaki Miki
- Department of Ophthalmology, Kansai Medical University Medical Center, Osaka, Japan
| | - Hisanori Imai
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Makoto Nakamura
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| |
Collapse
|