1
|
Sayanagi K, Fujimoto S, Hara C, Fukushima Y, Maruyama K, Kawasaki R, Sato S, Nishida K. Effect of polyp regression and reduction on treatment efficacy in polypoidal choroidal vasculopathy treated with aflibercept. Sci Rep 2024; 14:1833. [PMID: 38246960 PMCID: PMC10800340 DOI: 10.1038/s41598-024-52448-y] [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: 11/20/2023] [Accepted: 01/18/2024] [Indexed: 01/23/2024] Open
Abstract
Intravitreal injection of aflibercept (IVA) has successfully treated polypoidal choroidal vasculopathy (PCV), and polyp morphology is an important indicator of treatment efficacy. However, many studies have not reported the presence or absence of polyp regression and treatment outcomes, and few studies have reported polyp reduction and treatment outcomes in cases with residual polyps. We retrospectively measured the polyp area on indocyanine green angiography images before and after the IVA loading phase and investigated the regression and reduction of polyps and treatment outcomes of 81 eyes with PCV treated with IVA. We investigated the relationship between the presence or absence of complete regression of polyps and the percentage change in the polyp area and treatment outcomes. Eyes with complete polyp regression had significantly better visual acuity improvements compared with baseline at 12 months (P = 0.0108), fewer treatments (P = 0.0024), fewer recurrences during 12-months follow-up (P = 0.0010), and more "dry maculas" at 3 months (P = 0.0048) than eyes in which polyp regression did not occur. A significant correlation was seen only between the percentage of polyp regression and visual acuity at 3 months (P = 0.0395). Regarding IVA therapy for PCV, the presence or absence of complete polyp regression at the end of the loading phase affected the treatment outcome, whereas the degree of polyp reduction in cases of residual polyps had no effect.
Collapse
Affiliation(s)
- Kaori Sayanagi
- Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan.
| | - Satoko Fujimoto
- Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Chikako Hara
- Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Yoko Fukushima
- Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Kazuichi Maruyama
- Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Ryo Kawasaki
- Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Shigeru Sato
- Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Kohji Nishida
- Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan
| |
Collapse
|
2
|
Hoshino J, Matsumoto H, Nakamura K, Akiyama H. Predicting treatment outcomes of intravitreal brolucizumab for polypoidal choroidal vasculopathy through noninvasive assessment of polypoidal lesion blood flow with optical coherence tomography angiography. Sci Rep 2024; 14:961. [PMID: 38200216 PMCID: PMC10781761 DOI: 10.1038/s41598-024-51628-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/08/2024] [Indexed: 01/12/2024] Open
Abstract
We investigated the assessment of blood flow within polypoidal lesions using optical coherence tomography angiography (OCTA) to determine intravitreal brolucizumab (IVBr) efficacy for treating polypoidal choroidal vasculopathy (PCV). We retrospectively studied 46 eyes with PCV that completed 1-year IVBr treatment. Blood flow signals within polypoidal lesions were evaluated using OCTA after loading-phase treatment, and 1-year outcomes were compared between eyes in which blood flow signals disappeared versus persisting. After loading-phase treatment, blood flow signals within polypoidal lesions disappeared in 31 eyes and persisted in 15. In the former group, visual acuity improved significantly throughout the year (P < 0.01), while in the latter there was no significant difference between baseline and after 1 year. The total number of injections was significantly lower with than without disappearance of blood flow signals (6.0 vs. 6.9, P < 0.01). The intended injection interval at the last visit was significantly longer in the former than in the latter group (15.7 weeks vs. 12.5 weeks, P < 0.01). These results indicate that PCV cases showing disappearance of blood flow signals within polypoidal lesions by OCTA after loading-phase treatment had favorable 1-year outcomes of IVBr. Therefore, evaluating blood flow within polypoidal lesions by OCTA may allow noninvasive prediction of PCV treatment outcomes.
Collapse
Affiliation(s)
- Junki Hoshino
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hidetaka Matsumoto
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Kosuke Nakamura
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hideo Akiyama
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| |
Collapse
|
3
|
Gu X, Zhao X, Zhao Q, Wang Y, Chen Y. Recent Advances in Imaging Polypoidal Choroidal Vasculopathy with Swept-Source Optical Coherence Tomography Angiography. Diagnostics (Basel) 2023; 13:2458. [PMID: 37510200 PMCID: PMC10377931 DOI: 10.3390/diagnostics13142458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/27/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
The gold standard for polypoidal choroidal vasculopathy (PCV) diagnosis is indocyanine green angiography (ICGA), but optical coherence tomography angiography (OCTA) has shown promise for PCV imaging in recent years. However, earlier generations of OCTA technology lacked the diagnostic efficacy to replace ICGA. Swept-source optical coherence tomography angiography (SS-OCTA), the latest generation of OCTA technology, has significantly improved penetrating ability, scanning speed, scanning range, and overall image quality compared with earlier generations of OCTA. SS-OCTA reveals a "tangled vasculature" pattern of polypoidal lesions (PLs), providing evidence that they are neovascular rather than aneurysmal structures. New choroidal biomarkers, such as the choriocapillaris flow void (FV), have been identified to explain the development of PCV lesions. Although no direct comparison between SS-OCTA and previous OCTA generations in terms of diagnostic capability has been performed, SS-OCTA has shown several advantages in differential diagnosis and monitoring early reactivation for PCV. These improvements make SS-OCTA a valuable tool for PCV diagnosis and follow-up, and it may become more important for this disease in the future. This review summarized recent advances in PCV morphology and structure, as well as the possible pathogenesis based on SS-OCTA findings. The value of SS-OCTA for PCV management is discussed, along with remaining issues, to provide an updated understanding of PCV and OCTA-guided management.
Collapse
Affiliation(s)
- Xingwang Gu
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xinyu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Qing Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yuelin Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| |
Collapse
|
4
|
Ahmed-Balestra D, Graf A, Stattin M, Haas AM, Kickinger S, Jacob M, Zehetner C, Krepler K, Ansari-Shahrezaei S. Optical Coherence Tomography Angiography Characteristics of Polypoidal Lesions in Caucasians. J Ophthalmol 2023; 2023:9597673. [PMID: 37347074 PMCID: PMC10281822 DOI: 10.1155/2023/9597673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/21/2023] [Accepted: 05/12/2023] [Indexed: 06/23/2023] Open
Abstract
Purpose The aim of the study is to analyze the swept source-optical coherence tomography angiography (SS-OCTA) characteristics of polypoidal lesions in Caucasian patients. Methods In this retrospective observational case series, 43 polypoidal lesions in 32 eyes of 32 patients were diagnosed using indocyanine green angiography (ICGA) and compared to SS-OCTA at a tertiary medical retina center (Clinic Landstraße, Vienna Healthcare Group, Austria) between June 2017 and March 2020. Vascularity was identified by color-coded B-scan SS-OCTA while morphology was described as revealed by en face SS-OCTA after alignment with ICGA-confirmed findings. Results In total, SS-OCTA detected all polypoidal lesions, as identified by ICGA. On B-scan SS-OCTA, circumscribed flow was detected in 33 (76.7%) polypoidal lesions and diffuse flow in 10 (23.3%) lesions. On en face SS-OCTA, polypoidal lesions appeared morphologically as 19 tangled vessel balls (44.2%), 6 tangled vessel balls next to dilated vessels (13.9%), 8 vascular dilatations (18.6%), and 8 ill-defined vascular networks (18.6%), leaving 2 lesions (4.6%) undetected. Circumscribed flow was significantly associated with tangled vessel balls (p = 0.005). Conclusion This study highlights the importance of a multimodal imaging approach, including SS-OCTA, for the evaluation of polypoidal lesions. Our findings suggest a morphological heterogeneity of vascular patterns in Caucasian patients with polypoidal lesions, as pictured by SS-OCTA.
Collapse
Affiliation(s)
- Daniel Ahmed-Balestra
- Karl Landsteiner Institute for Retinal Research and Imaging, Juchgasse 25, Vienna 1030, Austria
- Department of Ophthalmology, Clinic Landstraße, Vienna Healthcare Group, Juchgasse 25, Vienna 1030, Austria
| | - Alexandra Graf
- Institute of Medical Statistics, Medical University of Vienna, Spitalgasse 23, Vienna 1090, Austria
| | - Martin Stattin
- Karl Landsteiner Institute for Retinal Research and Imaging, Juchgasse 25, Vienna 1030, Austria
- Department of Ophthalmology, Clinic Landstraße, Vienna Healthcare Group, Juchgasse 25, Vienna 1030, Austria
- Department of Ophthalmology, Medical University of Innsbruck, Anichstraße 35, Innsbruck 6020, Austria
| | - Anna-Maria Haas
- Karl Landsteiner Institute for Retinal Research and Imaging, Juchgasse 25, Vienna 1030, Austria
- Department of Ophthalmology, Clinic Landstraße, Vienna Healthcare Group, Juchgasse 25, Vienna 1030, Austria
| | - Stefan Kickinger
- Karl Landsteiner Institute for Retinal Research and Imaging, Juchgasse 25, Vienna 1030, Austria
- Department of Ophthalmology, Clinic Landstraße, Vienna Healthcare Group, Juchgasse 25, Vienna 1030, Austria
| | - Michael Jacob
- Karl Landsteiner Institute for Retinal Research and Imaging, Juchgasse 25, Vienna 1030, Austria
- Department of Ophthalmology, Clinic Landstraße, Vienna Healthcare Group, Juchgasse 25, Vienna 1030, Austria
| | - Claus Zehetner
- Department of Ophthalmology, Medical University of Innsbruck, Anichstraße 35, Innsbruck 6020, Austria
| | - Katharina Krepler
- Karl Landsteiner Institute for Retinal Research and Imaging, Juchgasse 25, Vienna 1030, Austria
- Department of Ophthalmology, Clinic Landstraße, Vienna Healthcare Group, Juchgasse 25, Vienna 1030, Austria
| | - Siamak Ansari-Shahrezaei
- Karl Landsteiner Institute for Retinal Research and Imaging, Juchgasse 25, Vienna 1030, Austria
- Department of Ophthalmology, Clinic Landstraße, Vienna Healthcare Group, Juchgasse 25, Vienna 1030, Austria
- Medical School, Sigmund Freud University Vienna, Campus Prater Freudplatz 3, Vienna 1020, Austria
- Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 1, Graz 8036, Austria
| |
Collapse
|
5
|
Ruamviboonsuk P, Lai TYY, Chen SJ, Yanagi Y, Wong TY, Chen Y, Gemmy Cheung CM, Teo KYC, Sadda S, Gomi F, Chaikitmongkol V, Chang A, Lee WK, Kokame G, Koh A, Guymer R, Lai CC, Kim JE, Ogura Y, Chainakul M, Arjkongharn N, Hong Chan H, Lam DSC. Polypoidal Choroidal Vasculopathy: Updates on Risk Factors, Diagnosis, and Treatments. Asia Pac J Ophthalmol (Phila) 2023; 12:184-195. [PMID: 36728294 DOI: 10.1097/apo.0000000000000573] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/09/2022] [Indexed: 02/03/2023] Open
Abstract
There have been recent advances in basic research and clinical studies in polypoidal choroidal vasculopathy (PCV). A recent, large-scale, population-based study found systemic factors, such as male gender and smoking, were associated with PCV, and a recent systematic review reported plasma C-reactive protein, a systemic biomarker, was associated with PCV. Growing evidence points to an association between pachydrusen, recently proposed extracellular deposits associated with the thick choroid, and the risk of development of PCV. Many recent studies on diagnosis of PCV have focused on applying criteria from noninvasive multimodal retinal imaging without requirement of indocyanine green angiography. There have been attempts to develop deep learning models, a recent subset of artificial intelligence, for detecting PCV from different types of retinal imaging modality. Some of these deep learning models were found to have high performance when they were trained and tested on color retinal images with corresponding images from optical coherence tomography. The treatment of PCV is either a combination therapy using verteporfin photodynamic therapy and anti-vascular endothelial growth factor (VEGF), or anti-VEGF monotherapy, often used with a treat-and-extend regimen. New anti-VEGF agents may provide more durable treatment with similar efficacy, compared with existing anti-VEGF agents. It is not known if they can induce greater closure of polypoidal lesions, in which case, combination therapy may still be a mainstay. Recent evidence supports long-term follow-up of patients with PCV after treatment for early detection of recurrence, particularly in patients with incomplete closure of polypoidal lesions.
Collapse
Affiliation(s)
| | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yasuo Yanagi
- Department of Ophthalmology and Microtechnology, Yokohama City University, Yokohama, Japan
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
- School of Medicine, Tsinghua University, Beijing, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Kelvin Y C Teo
- Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
| | - Srinivas Sadda
- Doheny Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Fumi Gomi
- Department of Ophthalmology, Hyogo Medical University, Hyogo, Japan
| | - Voraporn Chaikitmongkol
- Retina Division, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Andrew Chang
- Sydney Retina Clinic, Sydney Eye Hospital, University of Sydney, Sydney, NSW, Australia
| | | | - Gregg Kokame
- Division of Ophthalmology, Department of Surgery, University of Hawaii School of Medicine, Honolulu, HI
| | - Adrian Koh
- Eye & Retina Surgeons, Camden Medical Centre, Singapore, Singapore
| | - Robyn Guymer
- Centre for Eye Research Australia, University of Melbourne, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Judy E Kim
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI
| | - Yuichiro Ogura
- Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | | | | | | | - Dennis S C Lam
- The C-MER International Eye Research Center of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China
- The C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
| |
Collapse
|
6
|
Bo Q, Zhang M, Chen J, Jia H, Shen M, Sun M, Xu M, Feng J, Yan Q, Yu Y, Huang P, Li T, Wang F, Rosenfeld PJ, Sun X. Progression of Polypoidal Lesions Associated with Exudative Recurrence in Polypoidal Choroidal Vasculopathy. Ophthalmology 2023; 130:167-178. [PMID: 36152843 DOI: 10.1016/j.ophtha.2022.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 08/31/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To investigate the characteristics of the branching vascular network (BVN) and polypoidal lesions in polypoidal choroidal vasculopathy (PCV) to determine near-term indicators that may predict exudative recurrence. DESIGN Retrospective cohort study. PARTICIPANTS Patients with PCV receiving anti-vascular endothelial growth factor (VEGF) monotherapy or anti-VEGF plus photodynamic therapy were followed for at least 1 year using swept-source OCT angiography (SS-OCTA) imaging. METHODS Patients were divided into 2 groups based on whether exudative recurrence occurred during follow-up. Multiple parameters were collected and compared between the 2 groups, such as age, gender, visual acuity, number of polypoidal lesions, lesion area at the first SS-OCTA visit, and total lesion area change from the first SS-OCTA visit to the last SS-OCTA visit. To evaluate the association between SS-OCTA imaging-based risk factors and the exudative recurrences, imaging features associated with PCV such as BVN growth and polypoidal lesion progression (enlargement, new appearance, and reappearance) at each follow-up visit were analyzed. The time intervals from the nonexudative visit with lesion progression to the corresponding exudative recurrence visit were documented to explore their association with exudative recurrences. Cox regression and logistic regression analyses were used. MAIN OUTCOME MEASURES Association between BVN growth and polypoidal lesion progression with exudative recurrence. RESULTS Thirty-one eyes of 31 patients (61% men) were included. Sixteen eyes had no recurrence of exudation, and 15 eyes had recurrence during follow-up. The average follow-up duration was 20.55 ± 6.86 months (range, 12-36 months). Overall, the recurrence group had worse best-corrected visual acuity (P = 0.019) and a greater increase in lesion area (P = 0.010). Logistical regression analysis showed that polypoidal lesion progression, including new appearance, enlargement, and reappearance of polypoidal lesions, was associated with exudative recurrences within 3 months (odds ratio, 26.67, 95% confidence interval, 3.77-188.54, P = 0.001). CONCLUSIONS Growth of nonexudative BVN and progression of polypoidal lesions were found to be lesion characteristics associated with exudative recurrences, and progression of polypoidal lesions might serve as a stand-alone indicator for the near-term onset of exudation. In PCV, more frequent follow-up visits are recommended when polypoidal lesions show progression.
Collapse
Affiliation(s)
- Qiyu Bo
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Min Zhang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Jieqiong Chen
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China; Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
| | - Huixun Jia
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Mengxi Shen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Mengsha Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Mengqiao Xu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Jingyang Feng
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Quan Yan
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Yang Yu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Peirong Huang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Tong Li
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China; Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China.
| | - Fenghua Wang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China; Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China; Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China; Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.
| | - Philip J Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China; Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China; Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China; Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.
| |
Collapse
|
7
|
Switching to brolucizumab from aflibercept in age-related macular degeneration with type 1 macular neovascularization and polypoidal choroidal vasculopathy: an 18-month follow-up study. Graefes Arch Clin Exp Ophthalmol 2023; 261:345-352. [PMID: 35947181 DOI: 10.1007/s00417-022-05793-5] [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: 05/06/2022] [Revised: 07/24/2022] [Accepted: 07/29/2022] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To assess the effect of switching to brolucizumab from aflibercept on eyes with type 1 macular neovascularization (MNV) and polypoidal choroidal vasculopathy (PCV) at 18 months. METHODS This study was a retrospective, observational case series that included 19 eyes of 19 patients with type 1MNV and 23 eyes of 22 patients with PCV. We compared the injection intervals, visual acuity, total lesion size, and the number of polypoidal lesions between baseline and 18 months. The correlations between the data including treatment interval, total lesion size, and the number of polyps were also assessed. RESULTS Treatment intervals were significantly extended; from 7.4 ± 1.4 weeks to 11.6 ± 2.6 weeks for type 1 MNV, p < 0.001; from 6.9 ± 1.3 to 11.7 ± 3.1 weeks for PCV, p < 0.001. In type 1 MNV eyes, strong correlation was found between total lesion size and brolucizumab injection intervals (r = - 0.81; p = 0.0002) and moderate correlation was found between treatment frequency with aflibercept and that with brolucizumab (r = 0.76; p = 0.040). In PCV eyes, we found strong correlation between the number of polyps and brolucizumab treatment frequency (r = - 0.81; p = 0.0016) and moderate correlation between total lesion size and brolucizumab treatment interval (r = - 0.48; p = 0.034). Intraocular inflammation occurred in 2 of 19 eyes (10.3%) with type 1 MNV and 5 of 23 eyes (21.7%) with PCV. CONCLUSION The properties to extend brolucizumab injection intervals might be the smaller lesion size and lower aflibercept frequency for type 1 MNV and the smaller number of polyps and the smaller size of lesion for PCV.
Collapse
|
8
|
Chen L, Yuan M, Sun L, Chen Y. Different Morphology of Branching Neovascular Network in Polypoidal Choroidal Vasculopathy: A Swept-Source Optical Coherence Tomography Angiography Study. J Clin Med 2023; 12:jcm12030742. [PMID: 36769390 PMCID: PMC9918075 DOI: 10.3390/jcm12030742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/18/2023] Open
Abstract
Purpose: To evaluate the classification system of branching neovascular network (BNN) morphology in polypoidal choroidal vasculopathy (PCV) patients based on swept-source optical coherence tomography (SS-OCT) and swept-source optical coherence tomography angiography (SS-OCTA), and analyze the morphological features in each group as potential prognostic features. Methods: A total of 32 PCV eyes were included in this retrospective study. SS-OCT and SS-OCTA images of 6 mm × 6 mm centered on the foveal of each eye were analyzed. PCV cases were classified into three types ("trunk", "glomeruli", and "stick" type) based on the morphological features of BNN. OCT and OCTA features were compared among the three groups. The correlation of OCT/OCTA features with visual acuity at 12 months after anti-VEGF treatment was also analyzed. Results: Type 1 group had the largest BNN area and the largest numbers of polypoidal lesions. Type 2 group has the largest pigment epithelial detachment (PED) area, PED volume, subretinal fluid (SRF) area, and SRF volume. Type 3 group had better baseline BCVA, the smallest BNN area, the smallest PED size, and the smallest SRF size. Type 1 was also featured by a clear break on Bruch's membrane which corresponded to the origin of neovascular tissue. BCVA at 12 months was not significantly different among groups. Baseline BCVA and baseline central macular thickness were correlated with the final BCVA. Conclusions: The current classification system based on BNN morphology on SS-OCTA was highly applicable and revealed distinct characteristics in each group. The BNN type was not correlated with BCVA at 12 months after treatment.
Collapse
Affiliation(s)
- Lulu Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Mingzhen Yuan
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Lu Sun
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing 100730, China
- Correspondence: ; Tel.: +86-010-69156358; Fax: +86-010-69156565
| |
Collapse
|
9
|
Hua R, Zhang M. Imaging Characteristics of Neovascular and Atrophic Pachychoroidal Spectrum Diseases. Front Med (Lausanne) 2022; 9:891397. [PMID: 35860744 PMCID: PMC9289118 DOI: 10.3389/fmed.2022.891397] [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: 03/07/2022] [Accepted: 06/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThis study qualitatively and quantitatively compared imaging characteristics between neovascular and atrophic pachychoroid spectrum disease (PSD) by optical coherence tomography (OCT), and OCT angiography (OCTA).MethodsThe subtypes of PSD were identified by multi-modality imaging approaches. Subfoveal choroidal thickness (SFCT), choroidal vascular index (CVI), and vascular density of choroidal neovascularization (CNV) were measured.ResultsThe CVI and SFCT of 174 PSD eyes were 67.6% ± 5.48% and 362.2 ± 131.88 μm, respectively. After adjustment for age, linear regression indicated that SFCT was positively associated with CVI (p < 0.001), and patched hyper-reflective lesions in choriocapillaris layers (p = 0.009). Compared with neovascular PSD eyes, atrophic PSD eyes had similar patient age (57.1 ± 16.72 years, p = 0.639), SFCT (332.0 ± 111.00 μm, p = 0.51), and CVI (67.6% ± 3.94%, p = 0.527). There were no differences between polypoidal choroidal vasculopathy (PCV) eyes with aneurysmal polypoidal lesions and PCV eyes with tangled polypoidal lesions in terms of age, CVI, SFCT, vascular density, or the occurrence of double layer signs (DLSs, all p > 0.05). Logistic regression indicated that age (p = 0.003), SFCT (p = 0.003), patched hyper-reflective lesions in choriocapillaris layers (p = 0.009), and DLSs (p < 0.001) were predictive factors for CNV progression in PSD eyes (all p < 0.05).ConclusionsOur study highlighted the similarities in SFCT and CVI between neovascular and atrophic PSD, both of which were late stage lesions. Besides, age, SFCT, patched hyper-reflective lesions in choriocapillaris layers, and DLSs were risk factors for CNV in PSD. Our results showed that atrophic PSD is an important change in the late stage of PSD disease, which is helpful for in-depth understanding of the pathological mechanism of PSD and corresponding intervention.
Collapse
Affiliation(s)
- Rui Hua
- Department of Ophthalmology, First Hospital of China Medical University, Shenyang, China
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Meixia Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Meixia Zhang
| |
Collapse
|
10
|
Ebrahimiadib N, Mehrabi Bahar M, Riazi-Esfahani H, Pour EK, Ghassemi F, Faghihi H, Mirshahi A, Roohipourmoallai R, Lashay A, Mahmoudi A, Fadakar K. Flat irregular pigment epithelial detachment over time and outcome of different treatment regimens. Sci Rep 2022; 12:10750. [PMID: 35750709 PMCID: PMC9232631 DOI: 10.1038/s41598-022-14762-1] [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: 02/15/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022] Open
Abstract
To present long-term visual and structural outcome of treatment in two forms of flat irregular pigment epithelial detachment (FIPED): avascular (aFIPED) and vascularized (vFIPED) in eyes within pachychoroid spectrum. Prospective interventional case series. FIPED were classified into two subgroups; aFIPED and vFIPED based on OCTA. aFIPED underwent PDT, and vFIPED underwent either PDT, IVB, or combination of PDT&IVB. Vision, subretinal or intraretinal fluid, and choroidal biomarkers such as choroidal thickness, area, choroidal vascular index (CVI), and PED area were measured at baseline and last follow-up. Fifteen eyes with aFIPED were followed for a mean of 14.7 ± 10.8 months. Their vision improved, (0.44 ± 0.37–0.33 ± 0.40 LogMAR, p = 0.009) with significant reduction of fluid, choroidal area, thickness, PED area and increase in CVI. Twenty eyes with vFIPED were followed for a mean of 16.5 ± 8.2 months. The same pattern of choroidal alterations without visual improvement was observed in eyes underwent PDT alone. Combination therapy resulted in improvement of vision (0.38 ± 0.10–0.23 ± 0.17 LogMAR, p = 0.006) with reduction of choroidal area and thickness, with an increase in CVI. IVB alone could not change vision or choroidal structure. Single session PDT may lead to sustained visual improvement and structural change in eyes with aFIPED. Combination of PDT and IVB may be a better choice in eyes with vFIPED.
Collapse
Affiliation(s)
- Nazanin Ebrahimiadib
- Eye Research Center, Farabi Eye Hospital, Retina Services, Tehran University of Medical Sciences, South Kargar Street, Qazvin SquareTehran, 1336616351, Iran
| | - Mohammadreza Mehrabi Bahar
- Eye Research Center, Farabi Eye Hospital, Retina Services, Tehran University of Medical Sciences, South Kargar Street, Qazvin SquareTehran, 1336616351, Iran
| | - Hamid Riazi-Esfahani
- Eye Research Center, Farabi Eye Hospital, Retina Services, Tehran University of Medical Sciences, South Kargar Street, Qazvin SquareTehran, 1336616351, Iran
| | - Elias Khalili Pour
- Eye Research Center, Farabi Eye Hospital, Retina Services, Tehran University of Medical Sciences, South Kargar Street, Qazvin SquareTehran, 1336616351, Iran
| | - Fariba Ghassemi
- Eye Research Center, Farabi Eye Hospital, Retina Services, Tehran University of Medical Sciences, South Kargar Street, Qazvin SquareTehran, 1336616351, Iran
| | - Hooshang Faghihi
- Eye Research Center, Farabi Eye Hospital, Retina Services, Tehran University of Medical Sciences, South Kargar Street, Qazvin SquareTehran, 1336616351, Iran
| | - Ahmad Mirshahi
- Eye Research Center, Farabi Eye Hospital, Retina Services, Tehran University of Medical Sciences, South Kargar Street, Qazvin SquareTehran, 1336616351, Iran
| | - Ramak Roohipourmoallai
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Alireza Lashay
- Eye Research Center, Farabi Eye Hospital, Retina Services, Tehran University of Medical Sciences, South Kargar Street, Qazvin SquareTehran, 1336616351, Iran
| | - Alireza Mahmoudi
- Eye Research Center, Farabi Eye Hospital, Retina Services, Tehran University of Medical Sciences, South Kargar Street, Qazvin SquareTehran, 1336616351, Iran
| | - Kaveh Fadakar
- Eye Research Center, Farabi Eye Hospital, Retina Services, Tehran University of Medical Sciences, South Kargar Street, Qazvin SquareTehran, 1336616351, Iran.
| |
Collapse
|
11
|
Fukuyama H, Komuku Y, Araki T, Gomi F. ASSOCIATION OF FLOW SIGNALS WITHIN POLYPS ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY WITH TREATMENT RESPONSES AFTER COMBINATION THERAPY FOR POLYPOIDAL CHOROIDAL VASCULOPATHY. Retina 2022; 42:942-948. [PMID: 34954774 DOI: 10.1097/iae.0000000000003395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the changes of blood circulation within the polypoidal lesions by OCT angiography in eyes with polypoidal choroidal vasculopathy after combination therapy with aflibercept and photodynamic therapy. METHODS A total of 46 eyes from 46 patients who underwent the combination therapy for polypoidal choroidal vasculopathy were followed for more than 6 months. OCT angiography, covering an area 6 mm2 × 6 mm2 including the macula, were performed at baseline, 2 weeks, and 3 months and 6 months post-treatment. RESULTS The subretinal fluid resolved within 3 months after treatment in 44 eyes (95.7%), and 27 eyes (58.7%) showed no recurrence, with no additional treatment. Seventeen eyes (37.0%) showed recurrence, and two eyes (4.3%) showed poor response. On OCT angiography at 2 weeks after treatment, flow signals were detected in 3 of 27 eyes (11.1%) without recurrence and in 8 of 19 eyes (42.1%) with recurrence or poor responses. A detectable flow signal at 2 weeks was significantly associated with recurrence or poor response (P = 0.032). CONCLUSION Persistent flow signals within polyps on OCT angiography at 2 weeks after combination therapy suggest less effectiveness of the initial treatment.
Collapse
Affiliation(s)
- Hisashi Fukuyama
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
| | | | | | | |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Polypoidal Choroidal Vasculopathy Diagnosis and Neovascular Activity Evaluation Using Optical Coherence Tomography Angiography. BIOMED RESEARCH INTERNATIONAL 2021; 2021:1637377. [PMID: 34825001 PMCID: PMC8610682 DOI: 10.1155/2021/1637377] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022]
Abstract
Purpose To examine choroidal neovascularization (CNV) characteristics in patients with exudative age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV), using swept-source optical coherence tomography angiography (SS-OCTA), and investigate agreement with OCT B-scan, fundus fluorescein angiography (FFA), and indocyanine green angiography (ICGA) by two different examiners. Methods This is a retrospective multicentric study that involved patients with a history of AMD and PCV. Examiner A, who had access to OCTA, B-scan OCT, FFA, and ICGA imaging, had to differentiate between AMD and PCV, study the activity of AMD using Coscas' criteria (active vs. quiescent), and categorize PCV subtypes, while examiner B had only access to OCTA. Then, the diagnostic concordance was assessed between both examiners. Results A total of 27 patients (11 females (40.7%) and 16 males (59.3%), P = 0.231) were included in the analysis. Among those, 13 patients presented with neovascular AMD and 14 patients with PCV. There were 92.3% of correct answers regarding appropriate diagnosis and lesion characterization among AMD patients, against 61.5% of correct answers among PCV patients. The overall interrater reliability agreement between examiners, using Cohen's kappa coefficient (κ) was 0.70 (0.5082-0.8916). Disagreement was found with one active AMD misdiagnosed as inactive AMD, three inactive PCV misdiagnosed as inactive AMD, and one inactive PCV misdiagnosed as active AMD. Conclusion SS-OCTA alone remains limited in some specific phenotypes of PCV, which suggests the ongoing role of B-scan OCT associated with FFA and ICGA in the diagnosis of these conditions.
Collapse
|
14
|
Montero Hernández J, Remolí Sargues L, Monferrer Adsuara C, Castro Navarro V, Navarro Palop C, Cervera Taulet E. Optical coherence tomography angiography analysis of aneurismal type 1 neovascularization in a cohort of white patients. Eur J Ophthalmol 2021; 32:2338-2346. [PMID: 34628950 DOI: 10.1177/11206721211048801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION To evaluate the detection rate of aneurysmal type 1 neovascularization (AT1) in Caucasian patients using optical coherence tomography angiography (OCTA) and to describe OCTA characteristics of AT1 in a cohort of white patients. METHODS We conducted an observational retrospective study in 44 eyes of 43 patients with AT1. All patients underwent a complete ophthalmologic examination, including fundus imaging, indocyanine green angiography, optical coherence tomography, and OCTA. Branching vascular network (BVN) and polyp detection rates by OCTA were evaluated. Furthermore, we described BVN and polyp morphologies on en face OCTA and flow of polyps on B-scan OCTA. RESULTS En face OCTA revealed BVN in 84.09% of cases and polypoidal lesions in 86.36% of cases. B-scan OCTA showed BVN and polyps in 95.45% and 93.18% of the patients, respectively. "Trunk" BVNs (51.35%) and "ring" polyps (47.37%) were the most frequent morphologies observed in our cohort, and "patchy hyperflow" (80.49%) signal was the most common visualized in our patients. Regarding OCT parameters, CT under polyps was higher in patients with positive detection of polyps on B-scan OCTA. CONCLUSION OCTA is a possible diagnosis tool in Caucasian patients with AT1. To the best of our knowledge, this is the largest study performed in Caucasian patients regarding OCTA diagnostic abilities and features.
Collapse
Affiliation(s)
- Javier Montero Hernández
- Department of Ophthalmology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Lidia Remolí Sargues
- Department of Ophthalmology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Clara Monferrer Adsuara
- Department of Ophthalmology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Verónica Castro Navarro
- Department of Ophthalmology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Catalina Navarro Palop
- Department of Ophthalmology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Enrique Cervera Taulet
- Department of Ophthalmology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| |
Collapse
|
15
|
The Diagnostic Capability of Swept Source OCT Angiography in Treatment-Naive Exudative Neovascular Age-Related Macular Degeneration. J Ophthalmol 2021; 2021:6695918. [PMID: 34513087 PMCID: PMC8429016 DOI: 10.1155/2021/6695918] [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: 11/12/2020] [Revised: 01/19/2021] [Accepted: 02/04/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the capability of swept source-optical coherence tomography angiography (SS-OCTA) in the detection and localization of treatment-naive macular neovascularization (MNV) secondary to exudative neovascular age-related macular degeneration (nAMD). Methods In this prospective, observational case series, 158 eyes of 142 patients were diagnosed with exudative nAMD using fluorescein (FA) and indocyanine green angiography (ICGA) and evaluated by SS-OCTA in a tertiary retina center (Rudolf Foundation Hospital Vienna, Austria). The main outcome measure was the sensitivity of SS-OCTA compared to the standard multimodal imaging approach. Secondary outcome measure was the anatomic analysis of MNV in relation to the retinal pigment epithelium. Results En-face SS-OCTA confirmed a MNV in 126 eyes (sensitivity: 79.8%), leaving 32 eyes (20.2%) undetected. In 23 of these 32 eyes (71.9%), abnormal flow in cross-sectional SS-OCTA B-scans was identified, giving an overall SS-OCTA sensitivity of 94.3%. Eyes with a pigment epithelium detachment (PED) ≥ 300 μm had a smaller probability for correct MNV detection (p=0.015). Type 1 MNV showed a trend (p=0.051) towards smaller probability for the correct detection compared to all other subtypes. Other relevant factors for the nondetection of MNV in SS-OCTA were image artifacts present in 3 of 32 eyes (9.4%). SS-OCTA confirmed the anatomic localization of 93 in 126 MNVs as compared to FA (sensitivity: 73.8%). There was no influence of age, gender, pseudophakia, visual acuity, central foveal thickness, or subfoveal choroidal thickness on the detection rate of MNV. Conclusions SS-OCTA remains inferior to dye-based angiography in the detection rate of exudative nAMD consistent with type 1 MNV and a PED ≥300 µm. The capability to combine imaging modalities and distinguish the respective MNV subtype improves its diagnostic value.
Collapse
|
16
|
Affiliation(s)
- Xiang Fang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Tao Cui
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People's Republic of China
| | - Jianqing Qiu
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Wenli Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Hong Duan
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| |
Collapse
|
17
|
Fujita A, Kataoka K, Takeuchi J, Nakano Y, Horiguchi E, Kaneko H, Ito Y, Terasaki H. Reply. Retina 2021; 41:e54. [PMID: 33814538 DOI: 10.1097/iae.0000000000003173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ai Fujita
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Arias JD, Parra MM, Hoyos AT, Arango F, Viteri EJ, Arevalo JF. En face swept-source optical coherence tomography angiography choroidal vasculography (CVG) a tool to discriminate choroidal abnormalities in polypoidal choroidal vasculopathy. Expert Rev Med Devices 2021; 18:903-908. [PMID: 34329562 DOI: 10.1080/17434440.2021.1963230] [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] [Indexed: 10/20/2022]
Abstract
BACKGROUND Swept source optical coherence tomography angiography (SS-OCT-A) choroidal vasculography (CVG) is an imaging method which allows the evaluation of deep choroid details, being a promising too in choroidal pathologies as polypoidal choroidal vasculopathy (PCV). RESEARCH DESIGN AND METHODS Cross-sectional study performed at FOSCAL International Clinic in Colombia. CVG features in patients with PCV were evaluated using SS-OCT CVG. RESULTS Twenty-two eyes of 21 patients were included. The mean age was 72.7 ± 6.5 years old (range: 48.6-95.4 years old). Twelve (57.1%) patients were male. The mean number of polyps detected by SS-OCT-A CVG before treatment with anti-VEGF therapy was 2.04 ± 1.18, which decreased after treatment to 1.18 ± 0.71. This result was statistically significant (p < 0.05). All polypoidal lesions detected by B-scan were visualized using CVG. Polyp circularity and surrounding reflectivity indicated activity of disease. CONCLUSION En face SS-OCT-A CVG is an alternative tool to evaluate choroidal structure at different depths without a contrast dye, providing information for the diagnosis and follow-up of patients with PCV. This imaging modality do not pretend to replace gold standard tests in PCV as ICGA, but rather provides choroidal imaging features of PCV, when ICGA is not available.
Collapse
Affiliation(s)
- Juan D Arias
- Specialist in Retina, Vitreous and Oncology. Professor of Fellowship in Retina and Vitreous, FOSCAL Internacional - Universidad Autónoma De Bucaramanga, Floridablanca, Colombia
| | - M Margarita Parra
- Fellow of Retina and Vitreous, FOSCAL Internacional - Universidad Autónoma De Bucaramanga, Floridablanca, Colombia
| | - Andrea T Hoyos
- Specialist in Retina, Vitreous. Professor of Retina and Vitreous, Fundación Universitaria Sanitas, Bogotá, Colombia
| | - Francisco Arango
- Specialist in Retina, Vitreous, Hospital Militar, Bogotá, Colombia
| | - Eduardo J Viteri
- Fellow of Retina and Vitreous, FOSCAL Internacional - Universidad Autónoma De Bucaramanga, Floridablanca, Colombia
| | - J Fernando Arevalo
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
19
|
Takashi N, Nakamura A, Kataoka K, Usui Y, Ito Y, Kaneko H. Optical coherence tomography angiography for the diagnosis of granulomatosis with polyangiitis with serous retinal detachment: A case report. Medicine (Baltimore) 2021; 100:e24789. [PMID: 33607834 PMCID: PMC7899876 DOI: 10.1097/md.0000000000024789] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/29/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Granulomatosis with polyangiitis (GPA) is a rare systemic autoimmune disease of unknown etiology. GPA affects multiple ocular tissues, most commonly the orbit, conjunctiva, cornea, and sclera. Retinal and choroidal manifestations are rare in GPA, but they often include choroidal neovascularization (CNV). PATIENT CONCERNS A 36-year-old man was diagnosed with GPA. He had been taking oral steroid treatment for 8 years. He experienced disease recurrence and the dose of oral prednisolone was increased after steroid pulse therapy. Fundus examination showed small retinal pigment epithelial detachment and serous retinal detachment (SRD). Optical coherence tomography (OCT) revealed a protruded lesion inside the SRD. Fluorescein angiography (FA) showed a small, dot-shaped fluorescein leakage in the SRD, and indocyanine green fluorescein fundus angiography showed choroidal vascular hyperpermeability that was consistent with the hyperfluorescence seen with FA. We had to determine whether the protruded lesion inside the SRD was CNV secondary to the inflammation due to GPA or whether it was central serous chorioretinopathy (CSC)-like condition caused by high-dose steroid treatment. DIAGNOSES We confirmed that the SRD was due to CSC but not CNV because the protruded lesion examined by B-scan OCT angiography (OCTA) showed no blood flow. INTERVENTIONS We decided to reduce the dose of steroid. OUTCOMES Since the reduction of steroids, no sign of worsening in the protruded lesions with SRD has been observed. LESSONS We therefore propose the effectiveness of this advanced function of OCTA for the examination of blood flow signal images to detect CNV.
Collapse
Affiliation(s)
- Noriko Takashi
- Department of Ophthalmology, Nagoya University Graduate School of Medicine
- Department of Ophthalmology, Nagoya Medical Center, Nagoya
| | - Aya Nakamura
- Department of Ophthalmology, Nagoya University Graduate School of Medicine
- Department of Ophthalmology, Tsushima Municipal Hospital, Tsushima
| | - Keiko Kataoka
- Department of Ophthalmology, Nagoya University Graduate School of Medicine
| | - Yoshihiko Usui
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Yasuki Ito
- Department of Ophthalmology, Nagoya University Graduate School of Medicine
| | - Hiroki Kaneko
- Department of Ophthalmology, Nagoya University Graduate School of Medicine
| |
Collapse
|
20
|
Moraru AD, Costin D, Moraru RL, Costuleanu M, Brănișteanu DC. Current diagnosis and management strategies in pachychoroid spectrum of diseases (Review). Exp Ther Med 2020; 20:3528-3535. [PMID: 32905090 PMCID: PMC7464929 DOI: 10.3892/etm.2020.9094] [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: 06/05/2020] [Accepted: 07/06/2020] [Indexed: 12/25/2022] Open
Abstract
This review presents a systematic analysis of the literature regarding the pachychoroid disease spectrum nomenclature, diagnosis criteria and therapeutic options. Pachychoroid related diseases are a new concept, introduced into the ophthalmological nomenclature in 2013 and evolving both as concept and as classification since then. The six disorders included in this phenotype have some common characteristics (thick choroid, pachyvessels, attenuation of the choriocapillaris), but also show individual features. The classification of the pachychoroid spectrum was revised many times, with the recent addition of the focal choroidal excavation (FCE) and peripapillary pachychoroid syndrome (PPS). As the terminology is developing, so is the number of case reports and case series from the initial report in 2013 to 57 reports in 2019. This review takes into account both the current literature and the clinical experience of the authors, emphasizing the understanding of the pathogenesis and aiming to update the therapeutic options available.
Collapse
Affiliation(s)
- Andreea Dana Moraru
- Department of Ophthalmology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iaşi, Romania.,Department of Ophthalmology, 'Prof. N. Oblu' Clinical Hospital, 700309 Iași, Romania
| | - Dănuț Costin
- Department of Ophthalmology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iaşi, Romania.,Department of Ophthalmology, 'Prof. N. Oblu' Clinical Hospital, 700309 Iași, Romania
| | - Radu Lucian Moraru
- Department of Otorhinolaryngology, 'Transmed Expert' Medical Center, 700011 Iaşi, Romania
| | - Marcel Costuleanu
- Department of Physiopathology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iaşi, Romania
| | - Daniel Constantin Brănișteanu
- Department of Ophthalmology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iaşi, Romania.,'Retina Center' Eye Clinic, 700126 Iași, Romania
| |
Collapse
|
21
|
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.
Collapse
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.
| |
Collapse
|