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Sivaprasad S, Chandra S, Sadda S, Teo KYC, Thottarath S, de Cock E, Empeslidis T, Esmaeelpour M. Predict and Protect: Evaluating the Double-Layer Sign in Age-Related Macular Degeneration. Ophthalmol Ther 2024; 13:2511-2541. [PMID: 39150604 PMCID: PMC11408448 DOI: 10.1007/s40123-024-01012-y] [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: 05/29/2024] [Accepted: 07/24/2024] [Indexed: 08/17/2024] Open
Abstract
INTRODUCTION Advanced age-related macular degeneration (AMD) is a major cause of vision loss. Therefore, there is interest in precursor lesions that may predict or prevent the onset of advanced AMD. One such lesion is a shallow separation of the retinal pigment epithelium (RPE) and Bruch's membrane (BM), which is described by various terms, including double-layer sign (DLS). METHODS In this article, we aim to examine and clarify the different terms referring to shallow separation of the RPE and BM. We also review current evidence on the outcomes associated with DLS: firstly, whether DLS is predictive of exudative neovascular AMD; and secondly, whether DLS has potential protective properties against geographic atrophy. RESULTS The range of terms used to describe a shallow separation of the RPE and BM reflects that DLS can present with different characteristics. While vascularised DLS appears to protect against atrophy but can progress to exudation, non-vascularised DLS is associated with an increased risk of atrophy. Optical coherence tomography (OCT) angiography (OCTA) is the principal method for identifying and differentiating various forms of DLS. If OCTA is unavailable or not practically possible, simplified classification of DLS as thick or thin, using OCT, enables the likelihood of vascularisation to be approximated. Research is ongoing to automate DLS detection by applying deep-learning algorithms to OCT scans. CONCLUSIONS The term DLS remains applicable for describing shallow separation of the RPE and BM. Detection and classification of this feature provides valuable information regarding the risk of progression to advanced AMD. However, the appearance of DLS and its value in predicting AMD progression can vary between patients. With further research, individualised risks can be confirmed to inform appropriate treatment.
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Affiliation(s)
- Sobha Sivaprasad
- National Institute of Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
- University College London Institute of Ophthalmology, London, UK.
| | - Shruti Chandra
- National Institute of Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- University College London Institute of Ophthalmology, London, UK
| | - SriniVas Sadda
- Doheny Imaging Reading Center, Doheny Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kelvin Y C Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Sridevi Thottarath
- National Institute of Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Eduard de Cock
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Theo Empeslidis
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
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Niestrata M, Deeks JJ, Takwoingi Y, Sivaprasad S, Patel PJ, Keane PA, Kernohan A, Vale L, Denniston AK, Gale R, Khan AR, McKinnon W, Agarwal R, de Salvo G, Minos E, Barbeiro P, Chakravarthy U, Waheed NK, Madhusudhan S, Peto T, Balaskas K. Study protocol: optical coherence tomography angiography for the detection of neovascular age-related macular degeneration: a comprehensive multicentre diagnostic accuracy study in the UK-the ATHENA study. BMJ Open 2024; 14:e070857. [PMID: 38821570 PMCID: PMC11149127 DOI: 10.1136/bmjopen-2022-070857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/26/2023] [Indexed: 06/02/2024] Open
Abstract
INTRODUCTION The diagnosis of neovascular age-related macular degeneration (nAMD), the leading cause of visual impairment in the developed world, relies on the interpretation of various imaging tests of the retina. These include invasive angiographic methods, such as Fundus Fluorescein Angiography (FFA) and, on occasion, Indocyanine-Green Angiography (ICGA). Newer, non-invasive imaging modalities, predominately Optical Coherence Tomography (OCT) and Optical Coherence Tomography Angiography (OCTA), have drastically transformed the diagnostic approach to nAMD. The aim of this study is to undertake a comprehensive diagnostic accuracy assessment of the various imaging modalities used in clinical practice for the diagnosis of nAMD (OCT, OCTA, FFA and, when a variant of nAMD called Polypoidal Choroidal Vasculopathy is suspected, ICGA) both alone and in various combinations. METHODS AND ANALYSIS This is a non-inferiority, prospective, randomised diagnostic accuracy study of 1067 participants. Participants are patients with clinical features consistent with nAMD who present to a National Health Service secondary care ophthalmology unit in the UK. Patients will undergo OCT as per standard practice and those with suspicious features of nAMD on OCT will be approached for participation in the study. Patients who agree to take part will also undergo both OCTA and FFA (and ICGA if indicated). Interpretation of the imaging tests will be undertaken by clinicians at recruitment sites. A randomised design was selected to avoid bias from consecutive review of all imaging tests by the same clinician. The primary outcome of the study will be the difference in sensitivity and specificity between OCT+OCTA and OCT+FFA (±ICGA) for nAMD detection as interpreted by clinicians at recruitment sites. ETHICS AND DISSEMINATION The study has been approved by the South Central-Oxford B Research Ethics Committee with reference number 21/SC/0412.Dissemination of study results will involve peer-review publications, presentations at major national and international scientific conferences. TRIAL REGISTRATION NUMBER ISRCTN18313457.
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Affiliation(s)
- Magdalena Niestrata
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Jonathan J Deeks
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Yemisi Takwoingi
- Public Health and Epidemiology, University of Birmingham, Birmingham, UK
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Praveen J Patel
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Pearse A Keane
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Luke Vale
- Newcastle University, Newcastle upon Tyne, UK
| | | | - Richard Gale
- York Teaching Hospital NHS Foundation Trust, York, UK
| | | | | | - Ridhi Agarwal
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Evangelos Minos
- Ophthalmology, North West Anglia NHS Foundation Trust, Peterborough, UK
| | | | | | | | | | - Tunde Peto
- Faculty of Medicine Health and Life Sciences, Queen's University Belfast, Belfast, UK
| | - Konstantinos Balaskas
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, UCL, London, UK
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Shen X, Zhou T, Sun Z, Zheng Y, Lin B, Huang Y. Trends in application of fundus fluorescein angiography in fundus diseases during a recent ten-year period. Photodiagnosis Photodyn Ther 2024; 46:104029. [PMID: 38428785 DOI: 10.1016/j.pdpdt.2024.104029] [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: 12/28/2023] [Revised: 02/06/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE To analyze the trends in the application of fundus fluorescein angiography (FFA) in fundus diseases over ten years. METHOD It was a retrospective study. Patients who underwent FFA examinations between Jan 2012 and Dec 2021 in Eye Hospital of Wenzhou Medical University were included, excluding infants. Data included the fundus disease and examination time of FFA. RESULTS A total of 37,038 cases underwent FFA examinations in our hospital in the past decade, and the number of each year was 3,628, 2,232, 2,230, 2,351, 3,546, 3,924, 5,325, 4,202, 4,432 and 5,168 from 2012 to 2021, respectively. The top three diseases were central serous chorioretinopathy (CSC), diabetic retinopathy (DR) and retinal vein occlusion (RVO) over the years from 2012 to 2021. The fourth to eighth ranked diseases were uveitis, age-related macular degeneration (AMD), choroidal neovascularization (CNV), optic neuropathy (ON) and polypoid choroidal vasculopathy (PCV) 9 years from 2012 to 2020; while retinal artery occlusion (RAO) ranked eighth and PCV fell out of the first eight in 2021. Tumor, Eale's disease, macular hemorrhage (MH), epiretinal retinal membrane (ERM) and Coat's disease had consistent proportions over the years. There was a significant statistical difference in the proportion of disease components over the years from 2012 to 2021(p = 0.000). CONCLUSION Despite changes in annual distribution, CSC, DR, and RVO consistently ranked as the top three diseases requiring FFA examination. Changes might be related to the development of non-invasive fundus examination instruments and technologies. Indicated that FFA still hold its irreplaceable nature in diagnosing and understanding fundus diseases.
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Affiliation(s)
- Xiaoqiu Shen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Tingye Zhou
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Zuhua Sun
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yan Zheng
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Bing Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China.
| | - Ying Huang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China.
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Üney G, Hazırolan D, Ünlü N, Candan Ö. Pro re nata anti-VEGF treatment in pachychoroid neovasculopathy compared with age-related macular degeneration based on optical coherence tomography. Int Ophthalmol 2024; 44:164. [PMID: 38551696 DOI: 10.1007/s10792-024-03094-w] [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: 01/03/2024] [Accepted: 03/05/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE To compare anti-vascular endothelial growth factor (anti-VEGF) treatment in pachychoroid neovasculopathy (PNV) and age related macular degeneration (AMD). METHODS Cases having pro re nata (PRN) anti-VEGF treatment for choroidal neovascularization were reviewed and grouped as PNV and AMD. Groups were compared according to central foveal thickness (CFT), best corrected visual acuity (BCVA), and total injection over 12 months. The correlation of beginning choroidal thickness, CFT, and BCVA with final BCVA was analyzed. RESULTS Forty-seven PNV and 65 AMD cases were reviewed. Both the PNV group (p = 0.0001) and the AMD group (p = 0.003) had a significant improvement in BCVA and a significant decrease in CFT (p = 0.0001). However, BCVA was better at the 3-, 6-, and 12-month follow-up in PNV (p = 0.003, 0.002, 0.02). No significant CFT difference was observed between groups. The total number of injections was 5.7 ± 1.7 for PNV and 5.2 ± 1.5 for AMD (p = 0.09). Beginning BCVA was positively correlated with final BCVA in both groups. CONCLUSION The PRN treatment regimen was effective for PNV and AMD in terms of visual and anatomical outcomes. Visual response was better in PNV with PRN treatment with the same number of injections.
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Affiliation(s)
- Güner Üney
- Ankara Training and Research Hospital, University of Health Sciences, Hacettepe Mh. Ulucanlar Cd. No: 89, 06230, Altındağ, Ankara, Turkey.
| | - Dicle Hazırolan
- Ankara Training and Research Hospital, University of Health Sciences, Hacettepe Mh. Ulucanlar Cd. No: 89, 06230, Altındağ, Ankara, Turkey
| | - Nurten Ünlü
- Ankara Training and Research Hospital, University of Health Sciences, Hacettepe Mh. Ulucanlar Cd. No: 89, 06230, Altındağ, Ankara, Turkey
| | - Özlem Candan
- Ankara Training and Research Hospital, University of Health Sciences, Hacettepe Mh. Ulucanlar Cd. No: 89, 06230, Altındağ, Ankara, Turkey
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Shen E, Wang Z, Lin T, Meng Q, Zhu W, Shi F, Chen X, Chen H, Xiang D. DRFNet: a deep radiomic fusion network for nAMD/PCV differentiation in OCT images. Phys Med Biol 2024; 69:075012. [PMID: 38394676 DOI: 10.1088/1361-6560/ad2ca0] [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: 11/08/2023] [Accepted: 02/23/2024] [Indexed: 02/25/2024]
Abstract
Objective.Neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV) present many similar clinical features. However, there are significant differences in the progression of nAMD and PCV. and it is crucial to make accurate diagnosis for treatment. In this paper, we propose a structure-radiomic fusion network (DRFNet) to differentiate PCV and nAMD in optical coherence tomography (OCT) images.Approach.The subnetwork (RIMNet) is designed to automatically segment the lesion of nAMD and PCV. Another subnetwork (StrEncoder) is designed to extract deep structural features of the segmented lesion. The subnetwork (RadEncoder) is designed to extract radiomic features from the segmented lesions based on radiomics. 305 eyes (155 with nAMD and 150 with PCV) are included and manually annotated CNV region in this study. The proposed method was trained and evaluated by 4-fold cross validation using the collected data and was compared with the advanced differentiation methods.Main results.The proposed method achieved high classification performace of nAMD/PCV differentiation in OCT images, which was an improvement of 4.68 compared with other best method.Significance. The presented structure-radiomic fusion network (DRFNet) has great performance of diagnosing nAMD and PCV and high clinical value by using OCT instead of indocyanine green angiography.
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Affiliation(s)
- Erwei Shen
- School of Electronic and Information Engineering, Soochow University, Suzhou, Jiangsu 215006, People's Republic of China
| | - Zhenmao Wang
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou 515041, People's Republic of China
| | - Tian Lin
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou 515041, People's Republic of China
| | - Qingquan Meng
- School of Electronic and Information Engineering, Soochow University, Suzhou, Jiangsu 215006, People's Republic of China
| | - Weifang Zhu
- School of Electronic and Information Engineering, Soochow University, Suzhou, Jiangsu 215006, People's Republic of China
| | - Fei Shi
- School of Electronic and Information Engineering, Soochow University, Suzhou, Jiangsu 215006, People's Republic of China
| | - Xinjian Chen
- School of Electronic and Information Engineering, Soochow University, Suzhou, Jiangsu 215006, People's Republic of China
| | - Haoyu Chen
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou 515041, People's Republic of China
| | - Dehui Xiang
- School of Electronic and Information Engineering, Soochow University, Suzhou, Jiangsu 215006, People's Republic of China
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Cheung CMG. Macular neovascularization and polypoidal choroidal vasculopathy: phenotypic variations, pathogenic mechanisms and implications in management. Eye (Lond) 2024; 38:659-667. [PMID: 37803144 PMCID: PMC10920817 DOI: 10.1038/s41433-023-02764-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/07/2023] [Accepted: 09/18/2023] [Indexed: 10/08/2023] Open
Abstract
Advances in imaging have led to improved ability to characterize variations in clinical sub-phenotypes of macular neovascularization (MNV) in Age-related macular degeneration (AMD). Polypoidal choroidal vasculopathy (PCV) was initially described based on characteristic features observed in indocyanine green angiography (ICGA) and was thought to be a distinct entity from AMD. However, subsequent careful observations based on confocal scanning laser ophthalmoscopy-based ICGA, optical coherence tomography (OCT) and OCT angiography have led researchers to appreciate similarities between PCV lesion and type 1 MNV in typical neovascular AMD. Concurrently, clinical trials have shown that anti-VEGF monotherapy can achieve favourable visual outcome in the majority of eyes with PCV. These learnings have led to a shift in the way PCV is managed over the past decade. Recent studies have supported the use of non-ICGA based imaging modality to screen for PCV and the adoption of anti-VEGF monotherapy as initial therapy for PCV. A focus of recent research has been in the understanding of the role of choroidal alterations in the pathogenesis of PCV. The concept of pachychoroid in leading to outer retinal ischemia has garnered increasing support. Future research in this area should evaluate the potential of choroidal morphology in guiding personalized therapy in PCV.
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Affiliation(s)
- Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
- Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore.
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7
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Zhao J, Chandrasekaran PR, Cheong KX, Wong M, Teo K. New Concepts for the Diagnosis of Polypoidal Choroidal Vasculopathy. Diagnostics (Basel) 2023; 13:diagnostics13101680. [PMID: 37238165 DOI: 10.3390/diagnostics13101680] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/06/2023] [Accepted: 05/07/2023] [Indexed: 05/28/2023] Open
Abstract
Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular age-related macular degeneration (nAMD) that is characterized by a branching neovascular network and polypoidal lesions. It is important to differentiate PCV from typical nAMD as there are differences in treatment response between subtypes. Indocyanine green angiography (ICGA) is the gold standard for diagnosing PCV; however, ICGA is an invasive detection method and impractical for extensive use for regular long-term monitoring. In addition, access to ICGA may be limited in some settings. The purpose of this review is to summarize the utilization of multimodal imaging modalities (color fundus photography, optical coherence tomography (OCT), OCT angiography (OCTA), and fundus autofluorescence (FAF)) in differentiating PCV from typical nAMD and predicting disease activity and prognosis. In particular, OCT shows tremendous potential in diagnosing PCV. Characteristics such as subretinal pigment epithelium (RPE) ring-like lesion, en face OCT-complex RPE elevation, and sharp-peaked pigment epithelial detachment provide high sensitivity and specificity for differentiating PCV from nAMD. With the use of more practical, non-ICGA imaging modalities, the diagnosis of PCV can be more easily made and treatment tailored as necessary for optimal outcomes.
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Affiliation(s)
- Jinzhi Zhao
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- Tianjin Medical University Eye Hospital, Tianjin 300392, China
| | - Priya R Chandrasekaran
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Kai Xiong Cheong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Mark Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Kelvin Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore 169857, Singapore
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Szeto SKH, Hui VWK, Siu V, Mohamed S, Chan CKM, Cheung CYL, Hsieh YT, Tan CS, Chhablani J, Lai TYY, Ng DSC. Recent Advances in Clinical Applications of Imaging in Retinal Diseases. Asia Pac J Ophthalmol (Phila) 2023; 12:252-263. [PMID: 36650100 DOI: 10.1097/apo.0000000000000584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 10/24/2022] [Indexed: 01/19/2023] Open
Abstract
Many diseases that cause visual impairment, as well as systemic conditions, manifest in the posterior segment of the eye. With the advent of high-speed, high-resolution, reliable, and noninvasive imaging techniques, ophthalmologists are becoming more dependent on ocular imaging for disease diagnosis, classification, and management in clinical practice. There are rapid advances on the indications of multimodal retinal imaging techniques, including the application of ultra-widefield fundus angiography, fundus autofluorescence, optical coherence tomography, as well as optical coherence tomography angiography. This review summarizes and highlights the clinical applications, latest indications, and interpretations of multimodal imaging in age-related macular degeneration, polypoidal choroidal vasculopathy, diabetic macular edema, central serous chorioretinopathy, diabetic retinopathy, retinal vein occlusion, and uveitis.
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Affiliation(s)
- Simon Ka-Ho Szeto
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Vivian Wing Ki Hui
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Vivianna Siu
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Shaheeda Mohamed
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Carmen K M Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Carol Yim Lui Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Yi Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Colin S Tan
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
- 2010 Retina and Macula Centre, Hong Kong, China
| | - Danny Siu-Chun Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
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Chaikitmongkol V, Ozimek M, Srisomboon T, Patikulsila D, Fraser-Bell S, Chhablani J, Choovuthayakorn J, Watanachai N, Kunavisarut P, Rodríguez-Valdés PJ, Lozano-Rechy D, Lupidi M, Al-Sheikh M, Fung AT, Busch C, Mehta H, Gabrielle PH, Zur D, Ramon D, Sangkaew A, Ingviya T, Amphornprut A, Cebeci Z, Couturier A, Mendes TS, Giancipoli E, Iglicki M, Invernizzi A, Lains I, Rehak M, Sala-Puigdollers A, Okada M, Loewenstein A, Bressler NM. Polypoidal Choroidal Vasculopathy Based on Non-ICGA Criteria in White Patients With Neovascular Age-Related Macular Degeneration. Am J Ophthalmol 2022; 244:58-67. [PMID: 35952753 DOI: 10.1016/j.ajo.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE To determine prevalence of probable polypoidal choroidal vasculopathy (PCV) among White patients with neovascular age-related macular degeneration (nAMD) using non-indocyanine green angiography (ICGA) criteria DESIGN: Multicenter, multinational, retrospective, cross-sectional study. METHODS A total of 208 treatment-naive eyes from Hispanic and non-Hispanic White individuals diagnosed with nAMD were included. All underwent color fundus photography (CFP), optical coherence tomography (OCT), and fluorescein angiography (FFA). De-identified images of study eyes were sent to 2 groups of graders. Group 1 reviewed CFP, OCT, and FFA to confirm nAMD diagnosis. Group 2 reviewed CFP and OCT to determine highly suggestive features for PCV. Probable PCV diagnosis defined as the presence of ≥2 of 4 highly suggestive features for PCV: notched or fibrovascular pigment epithelial detachment (PED) on CFP, sharply-peaked PED, notched PED, and hyperreflective ring on OCT. RESULTS Eleven eyes were excluded because of poor image quality (6) or non-nAMD diagnosis (5). Of 197 eligible eyes (197 patients), the mean age (SD) was 78.8 years (8.9), 44.2% were men, 26.4% were Hispanic, and 73.6% were non-Hispanic White individuals; 41.1%, 23.4%, 9.1%, and 2.5% had ≥1, ≥2, ≥3, and 4 highly suggestive features. Results showed that 23.4% (95% CI, 17.6%-29.9%) had probable PCV diagnosis. Predominantly occult CNV was more frequently found in probable PCV than nAMD subgroup (84.8% vs 64.9%, P = .01). Hispanic White individuals had a lower prevalence of probable PCV than non-Hispanic White individuals (9.6% vs 28.2%, P = .006) CONCLUSIONS: These findings suggest that probable PCV occurs between 17.6% and 29.9% in White individuals with nAMD, and more commonly in non-Hispanic than in Hispanic White individuals.
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Affiliation(s)
- Voraporn Chaikitmongkol
- Retina Division (V.C., T.S., D.P., J.C., N.W., P.K., A.S.), Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Malgorzata Ozimek
- Department of General Ophthalmology (M.O.), Medical University in Lublin, Lublin, Poland; Eye Surgery Center Prof. Zagorski (M.O.), Nowy Sacz, Poland
| | - Titipol Srisomboon
- Retina Division (V.C., T.S., D.P., J.C., N.W., P.K., A.S.), Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Department of Ophthalmology (T.S.), Nakornping Hospital, Chiang Mai, Thailand
| | - Direk Patikulsila
- Retina Division (V.C., T.S., D.P., J.C., N.W., P.K., A.S.), Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Samantha Fraser-Bell
- Department of Ophthalmology (S.F.-B.), Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Jay Chhablani
- Retina Division (V.C., T.S., D.P., J.C., N.W., P.K., A.S.), Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Department of Ophthalmology (J.C.), University of Pittsburgh Eye Center, Pittsburgh, Pennsylvania, USA
| | - Janejit Choovuthayakorn
- Retina Division (V.C., T.S., D.P., J.C., N.W., P.K., A.S.), Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nawat Watanachai
- Retina Division (V.C., T.S., D.P., J.C., N.W., P.K., A.S.), Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Paradee Kunavisarut
- Retina Division (V.C., T.S., D.P., J.C., N.W., P.K., A.S.), Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Patricio J Rodríguez-Valdés
- Instituto de Oftalmologia y Ciencias Visuales (P.J.R.-V.), Hospital Zambrano Hellion, Tecnologico de Monterrey, Monterrey, Mexico
| | | | - Marco Lupidi
- Eye Clinic (L.R.), Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy; Fondazione per la Macula Onlus, Di.N.O.G.Mi., Section of Ophthalmology, University of Perugia, Perugia, Italy
| | - Mayss Al-Sheikh
- Department of Ophthalmology (M.A.-S.), University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Adrian T Fung
- Westmead and Central Clinical Schools (A.T.F.), Specialty of Ophthalmology and Eye Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Ophthalmology(A.T.F.), Faculty of Medicine, Health and Human Sciences, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Catharina Busch
- Department of Ophthalmology (C.B., M.R.), University of Leipzig, Leipzig, Germany
| | - Hemal Mehta
- Department of Ophthalmology (H.M.), Royal Free London NHS Foundation Trust, London, UK
| | | | - Dinah Zur
- Division of Ophthalmology (D.Z., D.R., A.L.), Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Ramon
- Division of Ophthalmology (D.Z., D.R., A.L.), Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Apisara Sangkaew
- Retina Division (V.C., T.S., D.P., J.C., N.W., P.K., A.S.), Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Thammasin Ingviya
- Department of Family Medicine and Preventive Medicine (T.I.), Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Atchara Amphornprut
- Retina Division, Department of Ophthalmology (A.A.), Faculty of Medicine, Rajvithi Hospital, Rangsit University, Bangkok, Thailand
| | - Zafer Cebeci
- Department of Ophthalmology (Z.C.), Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aude Couturier
- Ophthalmology Department A.C.), Université de Paris, AP-HP, Hôpital Lariboisière, Paris, France
| | - Thais Sousa Mendes
- Department of Ophthalmology (T.S.M.), Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Ermete Giancipoli
- Department of Ophthalmology (E.G.), "Ospedale Vito Fazzi", Piazza Filippo Muratore, Lecce, Italy
| | - Matias Iglicki
- University of Buenos Aires (M.I .), Buenos Aires, Argentina
| | - Alessandro Invernizzi
- Eye Clinic - Department of Biomedical and Clinical Science "Luigi Sacco" (A.I.)'', Luigi Sacco Hospital, University of Milan, Milan, Italy; Save Sight Institute, Discipline of Ophthalmology (A.I.), Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Ines Lains
- Department of Ophthalmology (I.L.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Matus Rehak
- Department of Ophthalmology (C.B., M.R.), University of Leipzig, Leipzig, Germany; Department of Ophthalmology (M.R.), Justus-Liebig University Giessen, Giessen, Germany
| | - Anna Sala-Puigdollers
- Retina Division (V.C., T.S., D.P., J.C., N.W., P.K., A.S.), Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Institut Clínic d'Oftalmologia (ICOF) (A.S.-P.), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Mali Okada
- Department of Ophthalmology (M.O.), Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Anat Loewenstein
- Division of Ophthalmology (D.Z., D.R., A.L.), Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Neil M Bressler
- Retina Division (N.M.B.), Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
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Zhalka FE, Moisseiev E, Rubowitz A. Polypoidal choroidal vasculopathy—characteristics and response to treatment with bevacizumab in caucasian patients. Int J Retina Vitreous 2022; 8:82. [DOI: 10.1186/s40942-022-00432-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Purpose
To investigate the features and treatment response in Caucasian patients with polypoidal choroidal vasculopathy (PCV), initially treated with bevacizumab.
Methods
45 eyes of 43 treatment-naïve patients with PCV were included in this retrospective study, all uniformly initially treated with three bevacizumab injections monthly. OCT characteristics and clinical parameters were recorded and analyzed at presentation, after the initial 3 bevacizumab injections and at the final follow up period.
Results
Following 3 monthly bevacizumab injections visual acuity significantly improved with a mean gain of one line of vision. Central macular thickness (CMT) significantly improved from a mean of 402.1 ± 130.8 μm at presentation to 322.0 ± 96.8 μm (p < 0.01). Subretinal fluid, intraretinal fluid and submacular hemorrhage significantly improved. 53% were later switched to aflibercept and showed better response in the central macular thickness in comparison to those in which bevacizumab injections were continued. No correlation was found between the presence of pachyvessels or increased choroidal thickness and the improvement in VA or CMT.
Conclusion
Fixed first-line treatment with intravitreal bevacizumab monotherapy in non-Asian PCV patients achieves satisfactory visual and anatomical outcomes.
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Wongchaisuwat P, Thamphithak R, Jitpukdee P, Wongchaisuwat N. Application of Deep Learning for Automated Detection of Polypoidal Choroidal Vasculopathy in Spectral Domain Optical Coherence Tomography. Transl Vis Sci Technol 2022; 11:16. [PMID: 36219163 PMCID: PMC9580222 DOI: 10.1167/tvst.11.10.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/29/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To develop an automated polypoidal choroidal vasculopathy (PCV) screening model to distinguish PCV from wet age-related macular degeneration (wet AMD). Methods A retrospective review of spectral domain optical coherence tomography (SD-OCT) images was undertaken. The included SD-OCT images were classified into two distinct categories (PCV or wet AMD) prior to the development of the PCV screening model. The automated detection of PCV using the developed model was compared with the results of gold-standard fundus fluorescein angiography and indocyanine green (FFA + ICG) angiography. A framework of SHapley Additive exPlanations was used to interpret the results from the model. Results A total of 2334 SD-OCT images were enrolled for training purposes, and an additional 1171 SD-OCT images were used for external validation. The ResNet attention model yielded superior performance with average area under the curve values of 0.8 and 0.81 for the training and external validation data sets, respectively. The sensitivity/specificity calculated at a patient level was 100%/60% and 85%/71% for the training and external validation data sets, respectively. Conclusions A conventional FFA + ICG investigation to differentiate PCV from wet AMD requires intense health care resources and adversely affects patients. A deep learning algorithm is proposed to automatically distinguish PCV from wet AMD. The developed algorithm exhibited promising performance for further development into an alternative PCV screening tool. Enhancement of the model's performance with additional data is needed prior to implementation of this diagnostic tool in real-world clinical practice. The invisibility of disease signs within SD-OCT images is the main limitation of the proposed model. Translational Relevance Basic research of deep learning algorithms was applied to differentiate PCV from wet AMD based on OCT images, benefiting a diagnosis process and minimizing a risk of ICG angiogram.
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Affiliation(s)
- Papis Wongchaisuwat
- Department of Industrial Engineering, Faculty of Engineering, Kasetsart University, Bangkok, Thailand
| | - Ranida Thamphithak
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Peerakarn Jitpukdee
- Department of Industrial Engineering, Faculty of Engineering, Kasetsart University, Bangkok, Thailand
| | - Nida Wongchaisuwat
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Dat DT, Hien NDTN, Quan NN, Tung MQ, Tam HC, Hung BV. Current Trends in Clinical Characteristics, Diagnosis, and Treatment of Polypoidal Choroidal Vasculopathy: A Perspective from Vietnam. J Clin Med 2022; 11:jcm11164678. [PMID: 36012915 PMCID: PMC9410352 DOI: 10.3390/jcm11164678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
Polypoidal choroidal vasculopathy (PCV) is a common choroidal disease in the Asian population including Vietnam and is characterized by subretinal red-orange nodules, pigmented epithelium detachment, and massive subretinal hemorrhage. The recent focus on PCV in Vietnam can be attributed to advancements in PCV diagnosis and treatment. However, there is a scarcity of published literature and clinical data on PCV in the Vietnamese population, highlighting a key knowledge gap in this region. In order to address this gap, we gathered the opinions of experienced clinicians and retinal experts in Vietnam and reviewed available medical literature with the aim of: (i) providing an overview of PCV in the Vietnamese population—in terms of epidemiology, clinical characteristics, and management; (ii) tailoring international/national guidelines for the diagnosis and management of PCV, in line with available resources and medical equipment in Vietnam; and (iii) identifying gaps in clinical data in order to guide future PCV research in Vietnam and other countries with similar clinical conditions. The present review will enable healthcare providers and researchers to gain insight into current clinical practices and the limitations of PCV management in Vietnam and provide optimal and effective solutions.
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Affiliation(s)
- Dang Tran Dat
- Outpatient Department, Vietnam National Eye Hospital, 85 Ba Trieu, Nguyen Du Ward, Hai Ba Trung District, Hanoi 100000, Vietnam
- Correspondence: ; Tel.: +84-903-555-986
| | - Nguyen Do Thi Ngoc Hien
- Department of Ophthalmology, Hanoi Medical University, 1 Ton That Tung Street, Hanoi 100000, Vietnam
| | - Nguyen Nhu Quan
- Phuong Dong International Eye Center, 71 Ngo Thoi Nhiem Street, District 3, Ho Chi Minh City 700000, Vietnam
| | - Mai Quoc Tung
- Department of Ophthalmology, Hanoi Medical University, 1 Ton That Tung Street, Hanoi 100000, Vietnam
| | - Hoang Chi Tam
- Ophthalmology and Refractive Surgery Department, FV Hospital, 6 Nguyen Luong Bang Street, Phu My Hung, District 7, Ho Chi Minh City 700000, Vietnam
| | - Bui Viet Hung
- Vitreoretial Department, Vietnam National Eye Hospital, 85 Ba Trieu, Nguyen Du Ward, Hai Ba Trung District, Hanoi 100000, Vietnam
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13
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Jiang Y, Qi S. Diagnostic Value of Spectral-Domain Optical Coherence Tomography for Polypoidal Choroidal Vasculopathy: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:878946. [PMID: 35783657 PMCID: PMC9242399 DOI: 10.3389/fmed.2022.878946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeTo evaluate the diagnostic value of spectral-domain optical coherence tomography (SD-OCT) for polypoidal choroidal vasculopathy (PCV).MethodsA search of electronic databases was conducted from 2010 to 2021 to review the relevant literature on SD-OCT to identify PCV and other lesions causing serious or serosanguinous retinal pigment epithelial detachment (PED), specifically neovascular age-related macular degeneration (nvAMD). The QUADAS-2 scale was used to evaluate the quality of the literature. We performed a meta-analysis, including heterogeneity tests, analyze and synthesize the study data, meta-regression analysis, subgroup analysis, Fagan's plot, sensitivity analysis and publication bias tests.ResultsA total of 12 related studies involving 1,348 eyes were included in this study, and the random-effects model was used for meta-analysis. The results showed that the pooled sensitivity of SD-OCT in the diagnosis of PCV was 0.87 (95% CI: 0.84–0.89), the pooled specificity was 0.83 (95% CI: 0.80–0.86), and the pooled positive/negative likelihood ratios were 5.38 (95% CI: 3.28–8.80) and 0.16 (95% CI: 0.10–0.25), respectively. The diagnostic odds ratio (DOR) was 36.07 (95% CI: 15.98–81.40), and the area under the sROC curve (AUC) was 0.9429. When the pre–test probability was set at 20%, the post-test positive and negative probabilities were 58% and 4%, respectively. Meta-regression indicated that race was the primary source of heterogeneity (P <0.05). The Deeks' funnel plot showed no significant publication bias in this study (P>0.05).ConclusionSD-OCT has high sensitivity and specificity for the diagnosis of PCV, as well as significant clinical applicability. Since color fundus photography (CFP) is more clinically available and can improve the diagnostic efficacy, we recommend SD-OCT combined with CFP to diagnose PCV, especially without indocyanine green angiography (ICGA).Systematic Review Registrationhttps://inplasy.com/inplasy-2021-12-0048/, identifier: INPLASY2021120048.
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Affiliation(s)
- Yang Jiang
- Department of Ophthalmology, Tianjin Baodi Hospital, Tianjin, China
- Baodi Clinical College, Tianjin Medical University, Tianjin, China
| | - Shixin Qi
- Department of Ophthalmology, Tianjin Baodi Hospital, Tianjin, China
- Baodi Clinical College, Tianjin Medical University, Tianjin, China
- *Correspondence: Shixin Qi
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14
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Wang Y, Bo Q, Jia H, Sun M, Yu Y, Huang P, Wang J, Xu N, Wang F, Wang H, Sun X. Small dome-shaped pigment epithelium detachment in polypoidal choroidal vasculopathy: an under-recognized sign of polypoidal lesions on optical coherence tomography? Eye (Lond) 2022; 36:733-741. [PMID: 33833415 PMCID: PMC8956584 DOI: 10.1038/s41433-020-01390-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 11/27/2020] [Accepted: 12/18/2020] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To evaluate the diagnostic accuracy of spectral-domain optical coherence tomography (SD-OCT) and swept-source optical coherence tomographic angiography (SS-OCTA) to identify polypoidal lesions in serous or serosanguinous maculopathy. MATERIALS AND METHODS A retrospective review of patients presenting pigment epithelial detachments (PEDs) with the diagnosis of polypoidal choroidal vasculopathy (PCV), neovascular age-related macular degeneration (nAMD), and central serous chorioretinopathy (CSC), all of which underwent SD-OCT, SS-OCTA, and indocyanine green angiography (ICGA). Typical features of polypoidal lesions on SD-OCT included sharply peaked PED, notched PED, and hyperreflective ring underneath PED. SS-OCTA feature was vascularized PEDs on cross-sectional images corresponding to cluster-like structures on en face images. The parameters of PEDs were measured for analysis. RESULTS Of 72 eyes, 30 had PCV, 22 had nAMD, and 20 had CSC. A total of 128 localized PEDs were detected on SD-OCT. Typical features on SD-OCT had a high specificity (94.0%) but a limited sensitivity (73.8%). SS-OCTA features provided a higher sensitivity (96.7%). PEDs of the polypoidal lesions unrecognized by SD-OCT were dome-shaped, with smaller ratio of height to base diameter and less area, and almost had heterogeneous internal reflectivity and a connected double-layer sign. Some lesions misidentified by SS-OCTA developed into ICGA-proven polypoidal lesions at follow-up visits. CONCLUSION A small dome-shaped PED with heterogeneous internal reflectivity and a connected double-layer sign on SD-OCT may suggest a polypoidal lesion of PCV. SS-OCTA may be a helpful tool to investigate preclinical PCV and observe the formation of polypoidal lesions.
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Affiliation(s)
- Yuwei Wang
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Qiyu Bo
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Huixun Jia
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Mengsha Sun
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Yang Yu
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peirong Huang
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Jing Wang
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Nana Xu
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Fenghua Wang
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Key Laboratory of Fundus Diseases, Shanghai, China
| | - Hong Wang
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Key Laboratory of Fundus Diseases, Shanghai, China
| | - Xiaodong Sun
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.412478.c0000 0004 1760 4628National Clinical Research Center for Eye Diseases, Shanghai, China ,grid.412478.c0000 0004 1760 4628Shanghai Key Laboratory of Fundus Diseases, Shanghai, China
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15
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Permadi AC, Djatikusumo A, Adriono GA. Optical coherence tomography in diagnosing polypoidal choroidal vasculopathy. Looking into the future: a systematic review and meta-analysis. Int J Retina Vitreous 2022; 8:14. [PMID: 35227320 PMCID: PMC8883730 DOI: 10.1186/s40942-022-00365-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/14/2022] [Indexed: 11/21/2022] Open
Abstract
Background Polypoidal choroidal vasculopathy (PCV) is an exudative maculopathy with features similar to wet age macular degeneration. The incidence of PCV is known to be higher in the Asian population compared to Caucasians. Imaging modality is needed to make the diagnosis of PCV. Although Indocyanine green angiography (ICGA) is still the gold standard, it is not routinely performed in vitreoretinal practice. Thus another imaging modality is currently a popular research area. Spectral domain optical coherence tomography (SD-OCT) has emerged as a new imaging modality mostly available in clinics. Some studies have reported the sensitivity and specificity of SD-OCT in diagnosing PCV with different results and thresholds. Methods Relevant studies from PubMed, Science Direct and Google Scholar databases were systematically searched. In random effect models using STATA 14 software, a meta-analysis was performed to determine the pooled diagnostic accuracy. QUADAS 2 was used to evaluate the risk of bias of each study by Revman 5.4 software. Results Seven eligible studies which met the inclusion and exclusion criteria were enrolled in this study. A total of 911 eyes were included to investigate the diagnostic accuracy of SD-OCT. As a result, the pooled sensitivity was 0.91 (95% CI 0.87–0.93), specificity 0.88 (95% 0.83–0.92), positive likelihood ratio 8, negative likelihood ratio 11, the area under the summary receiver operating characteristic curve 0.95 (95% CI 0.93–0.97), and diagnostic odds ratio 71.81 (95% CI 38.89–132.74). Conclusion SD-OCT provided a high diagnostic value for detecting PCV. Sharply peaked pigment epithelial detachment (PED), notched PED, bubble sign, multiple PED, and double-layer sign were the most common features found in PCV.
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16
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Mazzeo TJMM, Leber HM, da Silva AG, Freire RCM, Barbosa GCS, Criado GG, Jacob GAV, Machado CG, Gomes AMV. Pachychoroid disease spectrum: review article. Graefes Arch Clin Exp Ophthalmol 2021; 260:723-735. [PMID: 34648069 DOI: 10.1007/s00417-021-05450-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aim of this article is to do a comprehensive literature review about the current understandings of the pachychoroid disease spectrum, describing its multimodal imaging analysis, pathophysiology, differential diagnosis, and current types of management. METHODS This comprehensive literature review was performed based on a search on the PubMed database, of relevant pachychoroid published papers according to our current knowledge. DISCUSSION The pachychoroid disease spectrum, according to some authors, includes the following: pachychoroid pigment epitheliopathy (PPE), central serous chorioretinopathy (CSC), pachychoroid neovasculopathy (PNV), polypoidal choroidal vasculopathy (PCV)/aneurysmal type 1 neovascularization (AT1), and more recently focal choroidal excavation (FCE) and peripapillary pachychoroid syndrome (PPS). Each one of these entities will be described and discussed in this article. CONCLUSION Significant advances in multimodal imaging have enabled a better understanding of the typical choroidal changes in pachychoroid disease spectrum. The clinical knowledge and managing options about this disease significantly increased in the last years. However, it is still unclear why some eyes with typical pachychoroid disease phenotype show no evidence of RPE damage and subretinal fluid (uncomplicated pachychoroid) while others present progressive tissue damage, neovascularization, and atrophy.
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Affiliation(s)
| | | | | | | | | | | | | | - Cleide Guimarães Machado
- Retina and Vitreous Department, Suel Abujamra Institute, São Paulo, Brazil.,Retina and Vitreous Department, University of São Paulo (USP), São Paulo, Brazil
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Kelkar AS, Kelkar J, Bolisetty M, Kelkar SB. Visual outcomes, safety profile and morphometric response of optical coherence tomography biomarkers to ranibizumab biosimilar treatment in neovascular age-related macular degeneration: Real-world evidence. Indian J Ophthalmol 2021; 69:1469-1474. [PMID: 34011722 PMCID: PMC8302301 DOI: 10.4103/ijo.ijo_2977_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: The aim of this study was to evaluate the safety, efficacy, and morphological response of intravitreal ranibizumab biosimilar (Razumab) in neovascular age-related macular degeneration (n-AMD) up to 12 weeks. Methods: Retrospective analysis of 20 eyes of n-AMD receiving 4 weekly intravitreal Razumab. Main outcome measures were mean change in best-corrected visual acuity (BCVA), intraretinal-fluid (IRF), subretinal-fluid (SRF), central-subfield thickness (CSFT), maximum central-retinal thickness (CRT), and dimensions of pigment epithelial detachment (PED) from baseline to weeks 4, 8 and 12. Results: Improvement in BCVA was seen at all visits, although not significantly (4 weeks: P = 0.18; 8 weeks: P = 0.4; 12 weeks: P = 0. 06). At 12 weeks, 90% of eyes either maintained or had an improvement in BCVA, with 40% of them showing an improvement of ≥3-lines and only 5% of them losing ≥3-lines of visual acuity. The median PED height and PED width reduced by 20.5 µm (P = 0.03) and 557.5 µm (P = 0.14), respectively, along with a mean reduction of 57.26 µmin CSFT (P < 0.001) and 44.15 µm in CRT (P = 0.004), respectively, at 12 weeks. On qualitative analysis, resolution of SRF and IRF was observed in 45% and 25% of eyes ‘ at 12 weeks. There were no serious ocular or systemic side effects identified. Conclusion: In real-world scenario, Razumab is an efficacious and economical anti-vascular endothelial growth factor (anti-VEGF) agent for optimal management of n-AMD. The therapeutic outcomes demonstrated reasonable stabilization and improvement in visual acuity, favorable anatomical outcomes pertaining to OCT-biomarkers with an acceptable safety profile.
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Affiliation(s)
- Aditya S Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Jai Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
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18
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Vella G, Sacconi R, Borrelli E, Bandello F, Querques G. Polypoidal choroidal vasculopathy in a patient with early-onset large colloid drusen. Am J Ophthalmol Case Rep 2021; 22:101085. [PMID: 33898862 PMCID: PMC8056241 DOI: 10.1016/j.ajoc.2021.101085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/11/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To report a case of a 46-year-old patient affected by polypoidal choroidal vasculopathy (PCV) in large colloid drusen (LCD) and to show how switching to intravitreal injection of aflibercept could be considered as a useful treatment of PCV not responsive to other anti-vascular endothelial growth factor (VEGF) injections. Observations A 46-year-old woman was referred to our department with diagnosis of early-onset retinal drusen. Multimodal imaging confirmed the diagnosis of LCD in both eyes, complicated by suggestive PVC in the left eye. Due to the absence of anatomical improvement after 6 intravitreal injections of ranibizumab, the patient was switched and treated by a single injection of aflibercept, showing a complete anatomical and functional recovery. Conclusions and Importance This case suggests progressive development of PCV as a possible late evolution of degenerating LCD. In case of exudative complication, intravitreal aflibercept injection could be considered as a useful treatment, especially in patients who are not responsive to others anti-VEGF injections.
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Affiliation(s)
- Giovanna Vella
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy.,Ophthalmology, Department of Surgical, Medical, Molecular, Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Enrico Borrelli
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
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Azzolini C, Cattaneo J, Premoli L, Metrangolo C, Chiaravalli M, Donati S. The morphology of choroidal neovascularization in chronic central serous chorioretinopathy presenting with flat, irregular pigment epithelium detachment. Int Ophthalmol 2021; 41:2109-2116. [PMID: 33748901 PMCID: PMC8172501 DOI: 10.1007/s10792-021-01768-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 03/05/2021] [Indexed: 11/29/2022]
Abstract
Purpose To evaluate morphological characteristics of choroidal neovascularization in chronic central serous chorioretinopathy (CSC) presenting with flat and irregular pigment epithelium detachment (FIPED) by means of innovative multimodal imaging. Methods In this observational cross-sectional study, we examined 10 consecutive patients affected by chronic CSC and FIPED using fluorescein angiography (FA), indocyanine-green angiography (ICGA) and optical coherence tomography angiography (OCTA). A qualitative analysis of the nature and characteristics of neovascular membrane was performed, combining available multimodal imaging and literature data. Results Multiple areas of retinal pigment epithelium alterations, macular hypo- and hyperpigmentation and atrophic areas were identified. Spectral domain OCT (SD-OCT) showed subretinal fluid in 80% of eyes and the ‘double layer sign’ in all patients. Late FA phases showed staining areas without leakage in all eyes; ICGA showed a hyperfluorescent plaque with surrounding hypofluorescence in 80% of patients. OCTA detected characteristic neovascular networks in the outer retina within the FIPEDs, classified as filamentous vessels with a pruned tree-like pattern in five eyes and a tangled pattern in three eyes. The choriocapillaris network showed dark areas in 80% of eyes and diffuse dark spots in all eyes. Conclusion Multimodal imaging completes clinical characterization of FIPEDs in chronic CSC. This study using OCTA technology describes the phenotype of hidden neovascular lesions in shape and morphology.
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Affiliation(s)
- Claudio Azzolini
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria - ASST Sette Laghi, Varese, Italy
| | - Jennifer Cattaneo
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria - ASST Sette Laghi, Varese, Italy
| | - Laura Premoli
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria - ASST Sette Laghi, Varese, Italy
| | - Cristian Metrangolo
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria - ASST Sette Laghi, Varese, Italy
| | - Maurizio Chiaravalli
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria - ASST Sette Laghi, Varese, Italy
| | - Simone Donati
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria - ASST Sette Laghi, Varese, Italy.
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20
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Supanji S, Romdhoniyyah DF, Sasongko MB, Agni AN, Wardhana FS, Widayanti TW, Prayogo ME, Perdamaian ABI, Dianratri A, Kawaichi M, Oka C. Associations of ARMS2 and CFH Gene Polymorphisms with Neovascular Age-Related Macular Degeneration. Clin Ophthalmol 2021; 15:1101-1108. [PMID: 33737801 PMCID: PMC7961131 DOI: 10.2147/opth.s298310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/22/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to determine the association of ARMS2 A69S, ARMS2 del443ins54, and CFH Y402H polymorphisms with neovascular age-related macular degeneration (nAMD) for the first time in an Indonesian population. Patients and Methods Our case–control study involved 104 nAMD and 100 control subjects. AMD diagnosis was evaluated by retinal specialists based on color fundus photography and optical coherence tomography. The polymorphisms on CFH Y402H and ARMS2 A69S were analyzed by PCR-restriction fragment length polymorphism (PCR-RFLP), whereas ARMS2 del443ins54 was evaluated by PCR-based assay. Results Significant allelic associations with nAMD were detected on all polymorphisms (P<0.05), with stronger association with the ARMS2 A69S (OR 3.13; 95% CI 2.08–4.71; P<0.001) and ARMS2 del443ins54 (OR 3.28; 95% CI 2.17–4.95; P<0.001) polymorphisms than with CFH Y402H (OR 2.08; 95% CI 1.08–3.99; P=0.028). Genotype analysis showed a statistical difference between nAMD and the control group for all polymorphisms (P<0.05). However, the association with nAMD was weaker for CFH Y402H (P=0.043) than for ARMS2 A69S and ARMS2 del443ins54 (P<0.001). A significant interaction between ARMS2 A69S and hypertension was documented (OR 9.53; 95% CI 3.61–25.1; P<0.001). Conclusion Our findings indicate that ARMS2 A69S and ARMS2 del443ins54 polymorphisms are strongly associated with the risk of nAMD for the first time in an Indonesian population. The risk of nAMD increased when the presence of risk alleles from ARMS2 A69S was combined with the presence of hypertension.
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Affiliation(s)
- Supanji Supanji
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Department of Ophthalmology, Dr. Sardjito General Hospital, Yogyakarta, Indonesia.,Ophthalmology Clinic, Military Air Force Central Hospital Dr. Suhardi Hardjolukito, Yogyakarta, Indonesia.,Ophthalmology Clinic, Dr YAP Eye Hospital, Yogyakarta, Indonesia
| | - Dewi Fathin Romdhoniyyah
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Department of Ophthalmology, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Muhammad Bayu Sasongko
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Department of Ophthalmology, Dr. Sardjito General Hospital, Yogyakarta, Indonesia.,Ophthalmology Clinic, Dr YAP Eye Hospital, Yogyakarta, Indonesia
| | - Angela Nurini Agni
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Department of Ophthalmology, Dr. Sardjito General Hospital, Yogyakarta, Indonesia.,Ophthalmology Clinic, Dr YAP Eye Hospital, Yogyakarta, Indonesia
| | - Firman Setya Wardhana
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Department of Ophthalmology, Dr. Sardjito General Hospital, Yogyakarta, Indonesia.,Ophthalmology Clinic, Dr YAP Eye Hospital, Yogyakarta, Indonesia
| | - Tri Wahyu Widayanti
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Department of Ophthalmology, Dr. Sardjito General Hospital, Yogyakarta, Indonesia.,Ophthalmology Clinic, Dr YAP Eye Hospital, Yogyakarta, Indonesia
| | - Muhammad Eko Prayogo
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Department of Ophthalmology, Dr. Sardjito General Hospital, Yogyakarta, Indonesia.,Ophthalmology Clinic, Dr YAP Eye Hospital, Yogyakarta, Indonesia
| | - Ayudha Bahana Ilham Perdamaian
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Department of Ophthalmology, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Aninditta Dianratri
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Department of Ophthalmology, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Masashi Kawaichi
- Laboratory of Gene Function in Animals, Nara Institute of Science and Technology, Ikoma, Nara, Japan
| | - Chio Oka
- Laboratory of Gene Function in Animals, Nara Institute of Science and Technology, Ikoma, Nara, Japan
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Kaye R, Chandra S, Sheth J, Boon CJF, Sivaprasad S, Lotery A. Central serous chorioretinopathy: An update on risk factors, pathophysiology and imaging modalities. Prog Retin Eye Res 2020; 79:100865. [PMID: 32407978 DOI: 10.1016/j.preteyeres.2020.100865] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/02/2020] [Accepted: 04/27/2020] [Indexed: 02/08/2023]
Abstract
Central serous chorioretinopathy (CSC) is a common form of vision loss, typically seen in working-age men. The pathophysiology behind CSC still eludes us, however significant advances have been made in understanding this disease over the last decade using information from genetic and cell-based studies and imaging modalities. This review aims to give an overview of the current pathophysiology hypotheses surrounding CSC in addition to future directions in cellular work from human induced pluripotent stem cell derived choroidal endothelial cells from CSC patients. Furthermore, this review will provide the reader with an update on the clinical aspects of CSC including risk factors, diagnostic challenges and findings from multimodal imaging.
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Affiliation(s)
- Rebecca Kaye
- Faculty of Medicine, University of Southampton, University Hospital Southampton, Southampton, SO16 6YD, United Kingdom
| | - Shruti Chandra
- NIHR Moorfields Biomedical Research Centre, 162, City Road, London, EC1V 2PD, United Kingdom
| | - Jay Sheth
- Surya Eye Institute and Research Center, Mumbai, India
| | - Camiel J F Boon
- Leiden University Medical Centre, Department of Ophthalmology, P.O. Box 9600, 2300 RC, Leiden, the Netherlands; Amsterdam University Medical Centers, Department of Ophthalmology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, 162, City Road, London, EC1V 2PD, United Kingdom
| | - Andrew Lotery
- Faculty of Medicine, University of Southampton, University Hospital Southampton, Southampton, SO16 6YD, United Kingdom.
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22
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The comparison of spectral domain optical coherence tomography and indocyanine green angiography in the diagnosis of polypoidal choroidal vasculopathy. Int Ophthalmol 2020; 41:659-665. [PMID: 33057916 DOI: 10.1007/s10792-020-01622-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the diagnostic capability of spectral domain optical coherence tomography (SD-OCT) in patients with potential diagnostic findings for polypoidal choroidal vasculopathy (PCV). MATERIALS AND METHODS Ninety-three eyes with potential diagnostic findings for PCV were prospectively evaluated. Patients with multiple retinal pigment epithelial detachment (RPED), sharp RPED peak, RPED notch, hyporeflective lumen representing polyps, double-layer sign and the presence of hyperreflective intraretinal hard exudate were considered as PCV in SD-OCT. The sensitivity and specificity of SD-OCT in the diagnosis of PCV were determined by comparing SD-OCT-based diagnosis with indocyanine green angiography (ICGA). RESULTS Sixty-nine (74.2%) of 93 eyes included in the study were confirmed with ICGA and diagnosed as PCV. The sensitivity and specificity of SD-OCT for the diagnosis of PCV were 75.3% and 75%, respectively. CONCLUSION The SD-OCT-based method helps clinicians to develop appropriate diagnostic and treatment strategies for patients in whom ICGA cannot be used.
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23
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Kim K, Yang J, Feuer W, Gregori G, Kim ES, Rosenfeld PJ, Yu SY. A Comparison Study of Polypoidal Choroidal Vasculopathy Imaged with Indocyanine Green Angiography and Swept-Source Optical Coherence Tomography Angiography. Am J Ophthalmol 2020; 217:240-251. [PMID: 32445699 DOI: 10.1016/j.ajo.2020.05.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Indocyanine green angiography (ICGA) was compared with swept-source optical coherence tomography angiography (SS-OCTA) for the detection of polypoidal choroidal vasculopathy (PCV). DESIGN Retrospective, cross-sectional. METHODS Patients with treatment-naïve PCV based on ICGA imaging underwent same-day SS-OCTA imaging at Kyung Hee University Medical Center between April 2017 and November 2018. ICGA and SS-OCTA images were graded independently. SS-OCTA images were graded using both flow and structural information. Images were graded for the number of polypoidal lesions and the total lesion area, which included both the polypoidal lesions and the branching vascular networks (BVNs). RESULTS A total of 31 eyes from 30 patients were enrolled. Polypoidal lesions were identified in all eyes using both modalities, and there was agreement on the number of polypoidal lesions in 17 eyes (55%). In 12 eyes (39%), SS-OCTA graders identified a greater number of polypoidal lesions, and in 2 eyes (6%) ICGA graders identified more lesions. There was no significant difference in the lesion area measurements (standard deviation = 1.09, P = .08). The lesion with the largest difference in area measurements resulted from focal areas of atrophy, misdiagnosed as polypoidal lesions on ICGA, and a low-lying serous retinal pigment epithelial detachment erroneously identified as part of the BVN by ICGA graders. SS-OCTA imaging correctly diagnosed the focal areas of atrophy and the serous retinal pigment epitheial detachment. CONCLUSIONS SS-OCTA imaging was comparable to ICGA for the diagnosis of treatment-naïve PCV. However, SS-OCTA might be better than ICGA in correctly identifying both polypoidal lesions and BVNs in treatment-naïve PCV.
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Affiliation(s)
- Kiyoung Kim
- Department of Ophthalmology, Kyung Hee University Medical Center, Kyung Hee University, Seoul, South Korea
| | - Jin Yang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - William Feuer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Eung Suk Kim
- Department of Ophthalmology, Kyung Hee University Medical Center, Kyung Hee University, Seoul, South Korea
| | - Philip J Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Seung-Young Yu
- Department of Ophthalmology, Kyung Hee University Medical Center, Kyung Hee University, Seoul, South Korea.
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24
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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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Yamashiro K, Hosoda Y, Miyake M, Ooto S, Tsujikawa A. Characteristics of Pachychoroid Diseases and Age-Related Macular Degeneration: Multimodal Imaging and Genetic Backgrounds. J Clin Med 2020; 9:jcm9072034. [PMID: 32610483 PMCID: PMC7409179 DOI: 10.3390/jcm9072034] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/18/2020] [Accepted: 06/26/2020] [Indexed: 02/07/2023] Open
Abstract
The emergence of pachychoroid disease is changing the concept of age-related macular degeneration (AMD). The concept of pachychoroid diseases was developed through clinical observation of multimodal images of eyes with AMD and central serous chorioretinopathy; however, recent genetic studies have provided a proof of concept for pachychoroid spectrum disease, which should be differentiated from drusen-driven AMD. The genetic confirmation of pachychoroid concept further provides novel viewpoints to decode previously reported findings, which facilitates an understanding of the true nature of pachychoroid diseases and AMD. The purpose of this review was to elucidate the relationship between pachychoroid diseases and AMD by interpreting previous findings on pachychoroid diseases and AMD from the novel viewpoints of genetic associations. We confirmed that previous genetic studies supported the concept of pachychoroid diseases. From a genetic viewpoint, the presence of thick choroid and the presence of choroidal vascular hyperpermeability were important characteristics of pachychoroid spectrum diseases. Previous studies have also suggested the classification of polypoidal choroidal vasculopathy (PCV) into two subtypes, pachychoroid neovasculopathy and drusen-driven PCV. Genetic viewpoints will be beneficial to rearrange subtypes of drusen-driven AMD and pachychoroid spectrum diseases. Further genetic studies are needed to investigate pachyvessels, pachydrusen and the significance of polypoidal lesions in pachychoroid neovasculopathy and drusen-driven AMD/PCV.
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Affiliation(s)
- Kenji Yamashiro
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan; (Y.H.); (M.M.); (S.O.); (A.T.)
- Department of Ophthalmology, Japanese Red Cross Otsu Hospital, Otsu 520-8511, Japan
- Correspondence: ; Tel.: +81-75-751-3248; Fax: +81-75-752-0933
| | - Yoshikatsu Hosoda
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan; (Y.H.); (M.M.); (S.O.); (A.T.)
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan; (Y.H.); (M.M.); (S.O.); (A.T.)
| | - Sotaro Ooto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan; (Y.H.); (M.M.); (S.O.); (A.T.)
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan; (Y.H.); (M.M.); (S.O.); (A.T.)
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26
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Polypoidal choroidal vasculopathy in Canada. Can J Ophthalmol 2020; 55:199-211. [DOI: 10.1016/j.jcjo.2019.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/06/2019] [Accepted: 10/15/2019] [Indexed: 11/19/2022]
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Cheong KX, Teo KYC, Cheung CMG. Influence of pigment epithelial detachment on visual acuity in neovascular age-related macular degeneration. Surv Ophthalmol 2020; 66:68-97. [PMID: 32428539 DOI: 10.1016/j.survophthal.2020.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 12/16/2022]
Abstract
Pigment epithelial detachment (PED), the anatomical separation of the retinal pigment epithelium from the Bruch membrane, is common in many chorioretinal diseases, including neovascular age-related macular degeneration. PED is present in about 30% to 80% of neovascular age-related macular degeneration patients based on the CATT, EXCITE, and VIEW studies. The influence of PED on visual acuity is controversial as a result of inconsistent results reported by various studies. With advances in imaging technologies, it is possible to evaluate not only the presence or absence of PED, but also detailed quantitative parameters, such as height, width, greatest linear diameter, area, volume, and reflectivity within the PED. We performed a comprehensive literature review to evaluate the relationship of PED with visual acuity. In summary, the presence or persistence of a PED may still be compatible with relatively good visual acuity. There is no strong evidence that the presence of a PED or aspects of its morphology has a significant impact on visual acuity. The presence of a PED may be predictive of the need for more regular treatment. More well-designed studies with standardized PED definitions and classifications are needed to evaluate the relationship between PED and visual acuity.
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Affiliation(s)
- Kai Xiong Cheong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Kelvin Yi Chong Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore.
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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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29
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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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Chen LJ, Cheng CK, Yeung L, Yang CH, Chen SJ, Chen JT, Chen LJ, Chen SN, Chen WL, Cheng CK, Hsu SM, Hwang DK, Lai CC, Lai CH, Lee FL, Yang CH, Yang CM, Yeung L, Wu TT, Chen SJ. Management of polypoidal choroidal vasculopathy: Experts consensus in Taiwan. J Formos Med Assoc 2020; 119:569-576. [DOI: 10.1016/j.jfma.2019.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/08/2019] [Accepted: 04/18/2019] [Indexed: 10/26/2022] Open
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DIAGNOSTIC CHARACTERISTICS OF POLYPOIDAL CHOROIDAL VASCULOPATHY BASED ON B-SCAN SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY AND ITS INTERRATER AGREEMENT COMPARED WITH INDOCYANINE GREEN ANGIOGRAPHY. Retina 2020; 40:2296-2303. [DOI: 10.1097/iae.0000000000002760] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Polypoidal Choroidal Vasculopathy in Congolese Patients. J Ophthalmol 2020; 2020:4103871. [PMID: 32051763 PMCID: PMC6995324 DOI: 10.1155/2020/4103871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/21/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose Polypoidal choroidal vasculopathy (PCV) is a visually debilitating disease that mostly affects people of African and Asian heritage. Indocyanine green angiography (ICGA) is the recommended exploratory method for definitive diagnosis. The disease has been extensively described in Asians and Caucasians, but not in Africans. This study was conducted to document the clinical presentation and optical coherence tomography features of polypoidal choroidal vasculopathy (PCV) in Congolese patients. Methods A prospective case series of patients with PCV was performed between January 2017 and June 2019. Routine ocular examination was performed including best corrected visual acuity measurement, slit-lamp examination, dilated direct fundoscopy, and spectral domain optical coherence tomography (OCT). The diagnosis was based on a combination of clinical and OCT signs. Results Fourteen patients were diagnosed with PCV during this period. The average age was 64.7 ± 6.9 years. There were 8 females. Ten (71.4%) patients had systemic hypertension. Most patients (n = 9, 64.3%) had bilateral involvement. Blurred vision was the most common complaint (71.4%). The main clinical presentation was subretinal exudates, seen in 19 (82.6%) eyes of 11 (78.6%) patients and subretinal hemorrhage in 10 (43.5%) eyes. Macular localization was found in 16 eyes (69.5%) of 12 (85.7%) patients. Drusen were observed in 35.7% of the patients. On OCT imaging, thumb-like pigment epithelial detachment and subretinal exudation were the most frequent features, observed in 92.9% and 71.4% of the patients, respectively. Conclusions PCV in Congolese patients showed features that are more similar to those observed in Caucasians. In this setting where indocyanine green angiography is not available, OCT facilitates the diagnosis of PCV.
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Li ZX, Hu YJ, Atik A, Lu L, Hu J. Long-term observation of vitrectomy without subretinal hemorrhage management for massive vitreous hemorrhage secondary to polypoidal choroidal vasculopathy. Int J Ophthalmol 2019; 12:1859-1864. [PMID: 31850169 DOI: 10.18240/ijo.2019.12.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 06/25/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To describe the long-term observation of vitrectomy without subretinal hemorrhage (SRH) management for massive vitreous hemorrhage (VH) secondary to polypoidal choroidal vasculopathy (PCV). METHODS This is a retrospective, consecutive case series. A total of 86 eyes of 86 patients with >14d of massive VH associated with PCV were included. All patients underwent vitrectomy without SRH management, followed by intravitreal ranibizumab injections and/or photodynamic therapy (PDT) as needed. The main outcome measures were best-corrected visual acuity (BCVA), postoperative adverse events and the recurrence of VH. RESULTS The average follow-up period was 25.5±9.2mo (range 12-35mo). Mean BCVA at baseline (2.16±0.39 logMAR) had improved significantly, both 3mo after surgery (1.42±0.66 logMAR, P<0.001) and by the last visit (1.23±0.74 logMAR, P<0.001). The common postoperative complications included macular subretinal fibrosis in 14 eyes (16.3%) and ciliary body detachment in 4 eyes (4.7%). Nineteen eyes (22.1%) received following treatment with ranibizumab injections without/with PDT, and 15 (17.4%) were resolved. Four eyes (4.7%) had recurrent hemorrhage during the follow-up period. In multiple regression analysis, thicker SRH (beta=0.33, P=0.025) in the preoperative B-scan and the presence of foveal subretinal fibrosis (beta=0.28, P=0.018) in the follow up were associated with poor postoperative BCVA. CONCLUSION Vitrectomy without SRH management for massive VH secondary to PCV improved/stabilized visual function in the long-term observation. Eyes presenting with thicker SRH preoperatively and forming foveal subretinal fibrosis in the follow-up period tended to have worse BCVA.
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Affiliation(s)
- Zhi-Xi Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Yi-Jun Hu
- Aier School of Ophthalmology, Central South University, Changsha 410000, Hunan Province, China
| | - Alp Atik
- Royal Victorian Eye and Ear Hospital, Melbourne 3000, Australia
| | - Lin Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Jie Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
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Yeo NJY, Chan EJJ, Cheung C. Choroidal Neovascularization: Mechanisms of Endothelial Dysfunction. Front Pharmacol 2019; 10:1363. [PMID: 31849644 PMCID: PMC6895252 DOI: 10.3389/fphar.2019.01363] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/28/2019] [Indexed: 12/31/2022] Open
Abstract
Many conditions affecting the heart, brain, and even the eyes have their origins in blood vessel pathology, underscoring the role of vascular regulation. In age-related macular degeneration (AMD), there is excessive growth of abnormal blood vessels in the eye (choroidal neovascularization), eventually leading to vision loss due to detachment of retinal pigmented epithelium. As the advanced stage of this disease involves loss of retinal pigmented epithelium, much less attention has been given to early vascular events such as endothelial dysfunction. Although current gold standard therapy using inhibitors of vascular endothelial growth factor (VEGF) have achieved initial successes, some drawbacks include the lack of long-term restoration of visual acuity, as well as a subset of the patients being refractory to existing treatment, alluding us and others to hypothesize upon VEGF-independent mechanisms. Against this backdrop, we present here a nonexhaustive review on the vascular underpinnings of AMD, implications with genetic and systemic factors, experimental models for studying choroidal neovascularization, and interestingly, on both endothelial-centric pathways and noncell autonomous mechanisms. We hope to shed light on future research directions in improving vascular function in ocular disorders.
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Affiliation(s)
- Natalie Jia Ying Yeo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ebenezer Jia Jun Chan
- Division of Psychology, School of Social Sciences, College of Humanities, Arts, and Social Sciences, Nanyang Technological University, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Christine Cheung
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore, Singapore
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Yang J, Yuan M, Wang E, Xia S, Chen Y. Noninvasive multimodal imaging in diagnosing polypoidal choroidal vasculopathy. BMC Ophthalmol 2019; 19:229. [PMID: 31733642 PMCID: PMC6858976 DOI: 10.1186/s12886-019-1244-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/06/2019] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To investigate the diagnostic accuracy of noninvasive multimodal imaging methods in diagnosing polypoidal choroidal vasculopathy (PCV) and distinguishing PCV from typical neovascular age-related macular degeneration (nvAMD). METHODS Retrospective study. Imaging features of noninvasive multimodal imaging methods, including fundus photography (FP), B-scan optical coherence tomography (OCT), en face OCT, OCT angiography, and autofluorescence, of 103 eyes with PCV or typical nvAMD were reviewed. Diagnostic strategy was established based on imaging features and was validated in other 105 eyes with PCV or typical nvAMD. RESULTS Features of subretinal orange nodule on FP, thumb-like PED on OCT, notched PED on OCT, bubble sign on OCT, and Bruch's membrane depression under serosanguinous PED on OCT were more common. When the diagnostic strategy of using at least 2 of 5 features was performed, there is 0.88 sensitivity and 0.92 specificity for diagnosing PCV. The results of the validation test further confirmed the diagnostic strategy with 0.94 sensitivity and 0.93 specificity. CONCLUSIONS Noninvasive multimodal imaging, especially FP and B-scan OCT, provide high sensitivity and specificity for diagnosing PCV and distinguishing PCV from typical nvAMD, when at least 2 of 5 suggestive imaging features are present.
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Affiliation(s)
- Jingyuan Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingzhen Yuan
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Erqian Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Song Xia
- Department of Ophthalmology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China. .,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China.
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36
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IMPROVED DETECTION AND DIAGNOSIS OF POLYPOIDAL CHOROIDAL VASCULOPATHY USING A COMBINATION OF OPTICAL COHERENCE TOMOGRAPHY AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina 2019; 39:1655-1663. [DOI: 10.1097/iae.0000000000002228] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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37
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Zhan Z, Sun L, Jin C, Yang Y, Hu A, Tang M, Wang Z, Ding X. Comparison between non-visualized polyps and visualized polyps on optical coherence tomography angiography in polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 2019; 257:2349-2356. [DOI: 10.1007/s00417-019-04445-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/09/2019] [Accepted: 08/17/2019] [Indexed: 11/25/2022] Open
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O'Day R, Wickremasinghe SS. Incrementally does it: Multicolour imaging in polypoidal choroidal vasculopathy. Clin Exp Ophthalmol 2019; 47:569-570. [PMID: 31304673 DOI: 10.1111/ceo.13568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Roderick O'Day
- Ocular Oncology Service, Moorfields Eye Hospital and St Bartholomew's Hospital, London, UK.,Medical Retina Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Sanjeewa S Wickremasinghe
- Medical Retina Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
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39
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SENSITIVITY AND SPECIFICITY OF DETECTING POLYPOIDAL CHOROIDAL VASCULOPATHY WITH EN FACE OPTICAL COHERENCE TOMOGRAPHY AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina 2019; 39:1343-1352. [DOI: 10.1097/iae.0000000000002139] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Cheung CMG, Kim JE. Diagnosing Polypoidal Choroidal Vasculopathy Without Indocyanine Green Angiography. JAMA Ophthalmol 2019; 137:667-668. [DOI: 10.1001/jamaophthalmol.2019.0583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-National University of Singapore Medical School, Singapore
| | - Judy E. Kim
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee
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41
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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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Kumar A, Kumawat D, Sundar M D, Gagrani M, Gupta B, Roop P, Hasan N, Sharma A, Chawla R. Polypoidal choroidal vasculopathy: a comprehensive clinical update. Ther Adv Ophthalmol 2019; 11:2515841419831152. [PMID: 30834360 PMCID: PMC6393826 DOI: 10.1177/2515841419831152] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 01/22/2019] [Indexed: 12/16/2022] Open
Abstract
Polypoidal choroidal vasculopathy as a disease is yet to be comprehended completely. The clinical features consisting of huge serosanguineous retinal pigment epithelial and neurosensory layer detachments, although unique may closely mimick neovascular age-related macular degeneration and other counterparts. The investigative modalities starting from indocyanine angiography to optical coherence tomography angiography provide diagnostic challenges. The management strategies based on the available therapies are plenty and not vivid. A detailed review with clarifying images has been compiled with an aim to help the readers in getting a better understanding of the disease.
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Affiliation(s)
- Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Devesh Kumawat
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Dheepak Sundar M
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Meghal Gagrani
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Barkha Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Prakhyat Roop
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Nasiq Hasan
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anu Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Sheth J, Anantharaman G, Chandra S, Sivaprasad S. "Double-layer sign" on spectral domain optical coherence tomography in pachychoroid spectrum disease. Indian J Ophthalmol 2019; 66:1796-1801. [PMID: 30451181 PMCID: PMC6256905 DOI: 10.4103/ijo.ijo_377_18] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose: The “double-layer sign (DLS)” describes the shallow and irregular elevation of the retinal pigment epithelium from the underlying intact Bruch's membrane visualized on the spectral domain optical coherence tomography. In this study, we evaluated the frequency, characteristics of the space within the double layer and other features in the pachychoroid spectrum to aid the clinical diagnosis of these variants. Methods: This retrospective study evaluated the features of the DLS on multimodal imaging in consecutive patients with a clinical diagnosis of one of the four variants of pachychoroid: pachychoroid pigment epitheliopathy (PPE), pachychoroid neovasculopathy (PCN), chronic central serous chorioretinopathy (CCSCR), and polypoidal choroidal vasculopathy (PCV). The features of the DLS were graded by two masked graders. Results: Overall, 102 eyes of 79 consecutive patients with pachychoroid spectrum were identified for grading. Sixteen eyes with PPE did not show any evidence of DLS. The DLS was identified in 15/16 (93.75%) eyes with PCN, 11/35 (31.43%) with CCSCR, and 32/35 (91.43%) with PCV (P < 0.001). The space within the DLS showed moderate hyperreflectivity in all eyes with PCV and PCN, while the space in the DLS in CCSCR showed uniform hyporeflectivity in 10/11 (%) eyes. Conclusion: The DLS sign was most frequent in polypoidal vasculopathy and PCN. A hyporeflective gap within the DLS favored the diagnosis of CCSCR.
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Affiliation(s)
- Jay Sheth
- Department of Vitreo-Retina, Giridhar Eye Institute, Kochi, Kerala, India
| | | | - Shruti Chandra
- Department of Vitreo-Retina, Giridhar Eye Institute, Kochi, Kerala, India
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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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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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Huang CH, Yeh PT, Hsieh YT, Ho TC, Yang CM, Yang CH. Characterizing Branching Vascular Network Morphology in Polypoidal Choroidal Vasculopathy by Optical Coherence Tomography Angiography. Sci Rep 2019; 9:595. [PMID: 30679701 PMCID: PMC6345899 DOI: 10.1038/s41598-018-37384-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 12/05/2018] [Indexed: 01/08/2023] Open
Abstract
This study analyze the morphological characteristics of branching vascular networks (BVN) in polypoidal choroidal vasculopathy (PCV) using optical coherence tomography angiography (OCTA), and correlate imaging characteristics with clinical presentations. We presented a retrospective observational case series for fifty cases of PCV confirmed by indocyanine green angiography. Macular OCTA were done by the AngioVue. The PCV cases were classified by distinct morphologic patterns of BVN by two retina specialists and clinical features were analyzed. The sensitivity of polyp detection by OCTA was 86% after manual segmentation and that of BVN was 90%. Three distinct morphologic patterns of BVN were identified. (1) The “Trunk” pattern (47%) exhibited major vessel trunk with features including presence of drusens, thin choroid, and larger BVN area. (2) The “Glomeruli” pattern (33%) showed anastomotic vascular network without major trunk. (3) The “Stick” pattern (20%) had localized BVN and the thickest choroid. Subtypes 2 and 3 held higher recurrence rate. In conclusions, the precise visualization of BVN on OCTA supported that OCTA might be a noninvasive tool to study the morphology of BVN in PCV, which exhibits three different morphological types. Identifying the morphology of BVN has the potential to prognosticate outcomes in PCV patients.
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Affiliation(s)
- Chu-Hsuan Huang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Ting Yeh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tzyy-Chang Ho
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan. .,Department of Ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan.
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Palkar AH, Khetan V. Polypoidal choroidal vasculopathy: An update on current management and review of literature. Taiwan J Ophthalmol 2019; 9:72-92. [PMID: 31198666 PMCID: PMC6557071 DOI: 10.4103/tjo.tjo_35_18] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular age-related macular degeneration (nAMD), commonly seen in the Asian population. It is dissimilar in epidemiology, genetic heterogeneity, pathogenesis, natural history, and response to treatment in comparison to nAMD. Confocal scanning laser ophthalmoscopy-based simultaneous fluorescein angiography and indocyanine green angiography, spectral-domain optical coherence tomography (OCT) with enhanced depth imaging, swept-source OCT, and OCT angiography have improved the ability to detect PCV, understand its pathology, and monitor treatment response. A plethora of literature has discussed the efficacy of photodynamic therapy, anti-vascular endothelial growth factor (VEGF) monotherapy, and combination of both, but only a few studies with higher level of evidence and limited follow-up duration are available. This review discusses the understanding of PCV with respect to epidemiology, pathogenesis, clinical features, natural history, imaging techniques, and various treatment options. Recent clinical trials (EVEREST-II and PLANET study) have emphasized that either anti-VEGF monotherapy or combination treatment is equally capable to strike a balance between polyp regression and stabilization of visual acuity. The recurrent nature of the disease, the development of macular atrophy, and the long-term poor visual prognosis despite treatment are concerns that open avenues for further research.
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Affiliation(s)
- Amit Harishchandra Palkar
- Department of Vitreoretinal Services, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Vikas Khetan
- Department of Vitreoretinal Services, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Lai K, Zhou L, Zhong X, Huang C, Gong Y, Xu F, Ma L, Chen G, Cheng L, Lu L, Jin C. Morphological Difference of Choroidal Vasculature Between Polypoidal Choroidal Vasculopathy and Neovascular AMD on OCT: From the Perspective of Pachychoroid. Ophthalmic Surg Lasers Imaging Retina 2018; 49:e114-e121. [DOI: 10.3928/23258160-20181002-13] [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: 02/28/2018] [Indexed: 11/20/2022]
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49
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Chaikitmongkol V, Khunsongkiet P, Patikulsila D, Ratanasukon M, Watanachai N, Jumroendararasame C, Mayerle CB, Han IC, Chen CJ, Winaikosol P, Dejkriengkraikul C, Choovuthayakorn J, Kunavisarut P, Bressler NM. Color Fundus Photography, Optical Coherence Tomography, and Fluorescein Angiography in Diagnosing Polypoidal Choroidal Vasculopathy. Am J Ophthalmol 2018; 192:77-83. [PMID: 29753852 DOI: 10.1016/j.ajo.2018.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/30/2018] [Accepted: 05/03/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine sensitivity and specificity of polypoidal choroidal vasculopathy (PCV) diagnosis using color fundus photography (CFP), optical coherence tomography (OCT), and fundus fluorescein angiography (FFA) without indocyanine green angiography (ICGA). DESIGN Validity analysis. METHODS Treatment-naïve eyes with serous/serosanguinous maculopathy undergoing CFP, OCT, FFA, and ICGA imaging before treatment at a university hospital in Thailand (January 1, 2013 to June 30, 2015) were identified. Images of each subject were categorized into 4 sets (set A: CFP; set B: CFP+OCT; set C: CFP+FFA; set D: CFP+OCT+FFA). Six graders, 3 from Thailand (PCV endemic area) and 3 from the United States (nonendemic area), individually reviewed each set (without ICGA), and determined if the presumed diagnosis was PCV. In parallel, 2 other graders confirmed if each case had PCV or not using EVEREST criteria (including ICGA). Sensitivity and specificity of a PCV diagnosis with each set (without ICGA) were analyzed compared with diagnoses including ICGA. RESULTS Of 119 study eyes (113 subjects, 57% male, mean age ± SD 59.9 ± 13.8 years), definite PCV diagnosis was 40.3%. Sensitivity of sets A, B, C, D: 0.63 (95% confidence interval [CI]: 0.47-0.76), 0.83 (95% CI: 0.69-0.92), 0.54 (95% CI: 0.39-0.68), 0.67 (95% CI: 0.51-0.79); specificities: 0.93 (95% CI: 0.84-0.97), 0.83 (95% CI: 0.72-0.91), 0.97 (95% CI: 0.89-0.99), 0.92 (95% CI: 0.82-0.97); accuracies: 0.81 (95% CI: 0.73-0.88), 0.83 (95% CI: 0.76-0.90), 0.79 (95% CI: 0.73-0.87), 0.82 (95% CI: 0.74-0.88). Discrepancies between Thai and US graders existed through sets A, C, and D. CONCLUSIONS These data suggest that without ICGA, fundus photography combined with OCT provides high sensitivity and high specificity to diagnose PCV; adding FFA does not improve accuracy.
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Affiliation(s)
| | | | - Direk Patikulsila
- Retina Division, Department of Ophthalmology, Chiang Mai University, Chiang Mai, Thailand
| | - Mansing Ratanasukon
- Retina Division, Department of Ophthalmology, Prince of Songkla University, Songkhla, Thailand
| | - Nawat Watanachai
- Retina Division, Department of Ophthalmology, Chiang Mai University, Chiang Mai, Thailand
| | | | - Catherine B Mayerle
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ian C Han
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Pawara Winaikosol
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | | | - Paradee Kunavisarut
- Retina Division, Department of Ophthalmology, Chiang Mai University, Chiang Mai, Thailand
| | - Neil M Bressler
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Lin T, Dans K, Meshi A, Muftuoglu IK, Amador-Patarroyo MJ, Chen KC, Cheng L, Freeman WR. AGE-RELATED MACULAR DEGENERATION-ASSOCIATED PERIPAPILLARY CHOROIDAL NEOVASCULARIZATION IN THE ERA OF ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY. Retina 2018; 39:1936-1944. [PMID: 30028411 DOI: 10.1097/iae.0000000000002272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To characterize the natural history and response of age-related macular degeneration-associated peripapillary choroidal neovascularization to anti-vascular endothelial growth factor therapy. METHODS This was a retrospective case series of patients with peripapillary choroidal neovascularization secondary to neovascular age-related macular degeneration. All patients underwent complete ophthalmologic examination and retinal imaging including fluorescein angiography and spectral domain optical coherence tomography at each visit. Eyes with subretinal or intraretinal macular fluid were treated with anti-vascular endothelial growth factor monotherapy using a modified as-needed treatment algorithm. RESULTS Thirty-three eyes of 27 patients were included. The median age was 82 years (range, 62-94), and the median duration of follow-up was 65 months (range, 6-165). Fourteen eyes (58%) without fovea-involving fluid at baseline subsequently developed exudation after a median observation period of 16 months (range, 4-107). Ten of 24 eyes (42%) without initial macular fluid remained dry during the entire follow-up. The median number of injections required until complete fluid reabsorption was 3 (range, 1-21) during the first treatment cycle. The median time to fluid recurrence was 6 months (range, 3-74). CONCLUSION Peripapillary choroidal neovascularization secondary to wet age-related macular degeneration has a slow progression, may not require treatment for a prolonged period, and responds rapidly to anti-vascular endothelial growth factor treatment with good visual outcomes.
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