1
|
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.
Collapse
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
| |
Collapse
|
2
|
Ma F, Yuan M, Kozak I, Zhang Q, Chen Y. SENSITIVITY AND SPECIFICITY OF MULTISPECTRAL IMAGING FOR POLYPOIDAL CHOROIDAL VASCULOPATHY. Retina 2021; 41:1921-1929. [PMID: 33512897 DOI: 10.1097/iae.0000000000003130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the sensitivity and specificity of multispectral imaging (MSI), a noninvasive imaging technique composed of a series of monochromatic scanning light, for polypoidal choroidal vasculopathy (PCV). METHODS This was a prospective observational study. Polypoidal lesions on MSI are defined by oval or lobular hyperreflective oval lesion with dark hyporeflective center. Branching vascular networks on MSI is featured by hyperreflective interlacing signal. Detection sensitivity and specificity of polypoidal lesions was compared with indocyanine green angiography, whereas sensitivity and specificity of branching vascular networks, subretinal fluid, and pigment epithelium detachment were compared with optical coherence tomography. RESULTS Among 67 eyes, 38 eyes (56.7%) were diagnosed with PCV, 7 eyes (10.4%) with neovascular age-related macular degeneration, 13 eyes (19.4%) with central serous chorioretinopathy, 6 eyes (9.0%) with pathological myopia, and 3 eyes (4.5%) with idiopathic choroidal neovascularization. Compared with indocyanine green angiography, the sensitivity and specificity for diagnosing PCV by MSI alone was 84.21% and 93.10%, respectively, and the positive predictive value and the negative predictive value for PCV by MSI was 94.12% and 81.82%, respectively. The sensitivity and specificity for detecting polypoidal lesions were 84.21% and 93.10% compared with indocyanine green angiography. Compared with optical coherence tomography, the sensitivity and specificity for detecting branching vascular networks were 95.83% and 88.37%, for the subretinal fluid were 76.92% and 86.67%, and for the pigment epithelium detachment were 91.11% and 90.91%, respectively. CONCLUSION Multispectral imaging allowed noninvasive visualization of polypoidal lesions and branching vascular networks and may serve as a new diagnostic option for PCV.
Collapse
Affiliation(s)
- Feiyan Ma
- Department of Ophthalmology, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Mingzhen Yuan
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and
| | - Igor Kozak
- Department of ophthalmology, Moorfields Eye Hospitals UAE, Abu Dhabi, UAE
| | - Qing Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and
| |
Collapse
|
3
|
Borooah S, Sim PY, Phatak S, Moraes G, Wu CY, Cheung CMG, Pal B, Bujarborua D. Pachychoroid spectrum disease. Acta Ophthalmol 2021; 99:e806-e822. [PMID: 33258304 DOI: 10.1111/aos.14683] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/11/2020] [Accepted: 10/22/2020] [Indexed: 01/09/2023]
Abstract
Recent improvements in ophthalmic imaging have led to the identification of a thickened choroid or pachychoroid to be associated with a number of retinal diseases. The number of conditions linked to this phenotype has continued to widen with specific endophenotypes found within the pachychoroid spectrum. The spectrum includes choroidal features such as focal or diffuse choroidal thickening and thinning of the overlying inner choroid, and choroidal hyperpermeability as demonstrated by indocyanine green angiography. In addition, these diseases are associated with overlying retinal pigmentary changes and retinal pigment epithelial dysfunction and may also be associated with choroidal neovascularization. This article provides a comprehensive review of the literature looking at diseases currently described within the pachychoroid spectrum including central serous chorioretinopathy, pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy/aneurysmal type 1 neovascularization, peripapillary pachychoroid disease and focal choroidal excavation. We particularly focus on clinical imaging, genetics and pathological findings in these conditions with the aim of updating evidence suggesting a common aetiology between diseases within the pachychoroid spectrum.
Collapse
Affiliation(s)
- Shyamanga Borooah
- Shiley Eye Institute University of California San Diego La Jolla CA USA
- Moorfields Eye Hospital NHS Foundation Trust London UK
- Centre for Clinical Brain Sciences School of Clinical Sciences University of Edinburgh Edinburgh UK
| | - Peng Yong Sim
- Moorfields Eye Hospital NHS Foundation Trust London UK
- Royal Free Hospital London UK
| | - Sumita Phatak
- Moorfields Eye Hospital NHS Foundation Trust London UK
| | | | - Chris Yang Wu
- Shiley Eye Institute University of California San Diego La Jolla CA USA
| | | | | | | |
Collapse
|
4
|
Sumnicht AJ, Chalam KV, Alset AE, Sierpina DI. The role of oral steroids in the treatment of photodynamic therapy-associated exudative maculopathy, a case report and review of the literature. Photodiagnosis Photodyn Ther 2021; 35:102390. [PMID: 34119709 DOI: 10.1016/j.pdpdt.2021.102390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) is an effective treatment of pachychoroid spectrum disease. PDT can cause a rare complication known as PDT-associated exudative maculopathy (PAEM). Treatments including intravitreal anti-vascular endothelial growth factor (anti-VEGF) medications, local or systemic steroids, and observation have been attempted with variable success to address this complication. METHODS A thorough literature review was performed using the PubMed database on search terms aimed at treatments of PAEM. These cases were compared with each other and a novel case of PAEM in polypoidal choroidal vasculopathy (PCV) treated with oral prednisone by the authors. RESULTS Fifteen patients were compared; 11 were treated with anti-VEGF alone or in combination with intravitreal steroid and/or vitrectomy, one was treated with topical steroid, one was observed, one was treated with intravenous methylprednisolone, and one was treated with oral prednisone. The two cases treated with systemic steroids were given adjunctive sub-tenon's triamcinolone acetonide (STTA) after a favorable response was observed. Most cases had anatomic resolution of serous retinal detachment with stability of vision between 16 days and 2 months, with the most rapid resolution occurring in a patient with PCV treated with oral prednisone and STTA. CONCLUSIONS Reported treatment of PAEM includes intravitreal anti-VEGF agents with or without local or systemic steroids. Oral steroids may be advantageous in cases where there is concern regarding the risk profile of periocular steroids, intravitreal steroids or anti-VEGF agents. However, data describing the various treatments of this rare complication is limited, precluding firm conclusions regarding relative safety and efficacy.
Collapse
Affiliation(s)
| | | | - Adel E Alset
- Loma Linda University Eye Institute, Loma Linda, CA, USA
| | | |
Collapse
|
5
|
Chou YB, Hsu CH, Chen WS, Chen SJ, Hwang DK, Huang YM, Li AF, Lu HHS. Deep learning and ensemble stacking technique for differentiating polypoidal choroidal vasculopathy from neovascular age-related macular degeneration. Sci Rep 2021; 11:7130. [PMID: 33785808 PMCID: PMC8010118 DOI: 10.1038/s41598-021-86526-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/09/2021] [Indexed: 11/17/2022] Open
Abstract
Polypoidal choroidal vasculopathy (PCV) and neovascular age-related macular degeneration (nAMD) share some similarity in clinical imaging manifestations. However, their disease entity and treatment strategy as well as visual outcomes are very different. To distinguish these two vision-threatening diseases is somewhat challenging but necessary. In this study, we propose a new artificial intelligence model using an ensemble stacking technique, which combines a color fundus photograph-based deep learning (DL) model and optical coherence tomography-based biomarkers, for differentiation of PCV from nAMD. Furthermore, we introduced multiple correspondence analysis, a method of transforming categorical data into principal components, to handle the dichotomous data for combining with another image DL system. This model achieved a robust performance with an accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve of 83.67%, 80.76%, 84.72%, and 88.57%, respectively, by training nearly 700 active cases with suitable imaging quality and transfer learning architecture. This work could offer an alternative method of developing a multimodal DL model, improve its efficiency for distinguishing different diseases, and facilitate the broad application of medical engineering in a DL model design.
Collapse
Affiliation(s)
- Yu-Bai Chou
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chung-Hsuan Hsu
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsin Chu, Taiwan
| | - Wei-Shiang Chen
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsin Chu, Taiwan
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - De-Kuang Hwang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Ming Huang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - An-Fei Li
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Ophthalmology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Henry Horng-Shing Lu
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsin Chu, Taiwan.
| |
Collapse
|
6
|
The spectrum of polypoidal choroidal vasculopathy in Caucasians: clinical characteristics and proposal of a classification. Graefes Arch Clin Exp Ophthalmol 2020; 259:351-361. [PMID: 32812132 PMCID: PMC7843551 DOI: 10.1007/s00417-020-04844-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/06/2020] [Accepted: 07/10/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose To describe the clinical characteristics and outcome of polypoidal choroidal vasculopathy (PCV), also known as aneurysmal type 1 (sub-retinal pigment epithelium (RPE)) neovascularization, in Caucasian patients. Methods Single-centre study in 66 Caucasian patients with a diagnosis of PCV based on optical coherence tomography scan and indocyanine green angiography. Clinical characteristics and multimodal imaging were collected and assessed by an experienced retina specialist. Results This study involved 74 eyes of 66 patients with PCV, with a mean age at onset of 73 years and a female preponderance of 66%. The mean number of polypoidal lesions per eye was 1 (range: 1–5 lesions), out of which 75% was located in the macula and 19% in the peripapillary region. Of the 74 eyes, 37 eyes (50%) had PCV associated with a drusenoidal neovascular age-related macular degeneration (AMD) phenotype (PCV-AMD) and 18 eyes (24%) had PCV associated with non-polypoidal type 1 choroidal neovascularization/branching vascular network (PCV-BVN) without signs of drusenoidal AMD, while 19 eyes (26%) had idiopathic, isolated PCV (iPCV). The mean subfoveal choroidal thickness measured in 22 patients was 245 μm (range: 71–420 μm). In 51% of patients, the initially performed therapy showed good anatomical recovery (resolution of intra- and subretinal fluid). Conclusions A spectrum of PCV (aneurysmal type 1/sub-RPE neovascularization) can be seen in Caucasian patients. PCV associated with a drusenoidal neovascular AMD phenotype in Caucasians is phenotypically and presumably pathophysiologically more associated with neovascular AMD (PCV-AMD: type A PCV). However, this may not be the case for patients with PCV with non-polypoidal type 1 choroidal neovascularization or BVN and no signs of drusenoidal AMD (PCV-BVN: type B PCV), and for patients with idiopathic PCV without associated drusen or BVN (iPCV; type C PCV). Most patients have a thin choroid, even when drusen are absent. For the entire patient group, a moderate anatomical recovery was observed after treatment. Electronic supplementary material The online version of this article (10.1007/s00417-020-04844-z) contains supplementary material, which is available to authorized users.
Collapse
|
7
|
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.
Collapse
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.)
| |
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
Chi YT, Yang CH, Cheng CK. Optical Coherence Tomography Angiography for Assessment of the 3-Dimensional Structures of Polypoidal Choroidal Vasculopathy. JAMA Ophthalmol 2019; 135:1310-1316. [PMID: 29049501 DOI: 10.1001/jamaophthalmol.2017.4360] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Investigating the quantitative 3-dimensional (3-D) anatomy of polypoidal complex is important for a better understanding of the pathogenesis of polypoidal choroidal vasculopathy (PCV). Objective To quantitatively evaluate the 3-D characteristics of polypoidal structures, branching vascular networks (BVNs), and origin of PCV using optical coherence tomography angiography (OCTA) and multiple image systems. Design, Setting, and Participants A prospective, observational study was conducted in 47 consecutive Taiwanese patients (47 eyes) from May 21, 2015, to April 30, 2017. All participants were scanned with the Optovue-RTVue-XR-Avanti OCTA system. Patients in whom PCV was identified on OCTA were examined to define characteristics and structures of the original spouting vessels (stalks) from the choroid, polypoidal structures, and BVNs on OCTA. Main Outcomes and Measures Quantitative analysis of 3-D structures of the polypoidal complex. Results Among the 47 patients, the mean (SD) patient age was 68.9 (8.0) years, and 28 (59.6%) men were included. Clear images of polypoidal structures could be detected in 17 eyes (36.2%, 22 polypoidal structures), BVNs in 26 eyes (55.3%, 26 tufts of BVNs), and stalks of origin from the choroid in 26 eyes (55.3%, 26 stalks) on the en face plane on OCTA. All polypoidal structures were found at a mean (SD) height of 45.3 (36.1) μm above the retinal pigment epithelium (RPE) reference plane that was preset by the machine, while the BVNs were found at a mean (SD) depth of 28.6 (14.2) μm below the RPE reference plane and the choroidal stalks at 80.4 (24.4) μm below RPE reference plane. The mean (SD) thickness of polypoidal structures was 38.4 (15.5) μm and of BVNs, 60.2 (25.0) μm. The polypoidal structures were all above the Bruch membrane within the dome of the RPE detachment, the choroidal stalks were all in the choroid layer. The BVNs could be either above (up to 18 μm), within, or below (up to 28 μm) the Bruch membrane and were in proximity to the double layers of flattened RPE detachment. Conclusions and Relevance These results demonstrate a 3-D architecture of PCV that may be helpful for a better understanding of the anatomy, pathophysiology, and pathogenesis of PCV.
Collapse
Affiliation(s)
- Yu-Tien Chi
- Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology and School of Medicine, National Taiwan University, Taipei
| | - Cheng-Kuo Cheng
- Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan,Department of Ophthalmology and School of Medicine, National Taiwan University, Taipei,Department of Ophthalmology and School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| |
Collapse
|
10
|
Seong S, Choo HG, Kim YJ, Kim JY, Lee JH, Oh HS, You YS, Kim SH, Kwon OW. Novel Findings of Polypoidal Choroidal Vasculopathy via Optical Coherence Tomography Angiography. KOREAN JOURNAL OF OPHTHALMOLOGY 2019; 33:54-62. [PMID: 30746912 PMCID: PMC6372389 DOI: 10.3341/kjo.2018.0048] [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: 05/29/2018] [Accepted: 08/08/2018] [Indexed: 01/17/2023] Open
Abstract
Purpose To introduce novel findings of polypoidal choroidal vasculopathy (PCV) via optical coherence tomography angiography (OCTA) Methods This study is a retrospective chart review of 16 patients (16 eyes) with PCV. OCTA (Avanti RTVue XR) findings were evaluated and selected for analysis after agreement by two retina specialists . Results Twenty one polyps in 16 eyes (16 patients) with PCV were included in this study. The mean patient age was 67 years (13 men and three women). The shape of polypoidal lesions on OCTA at initial were halo (five polyps), rosette (seven polyps), and vascular network (nine polyps). Eight months after anti-vascular endothelial growth factor treatment, in a total of four eyes, seven polyps could be followed up completely, the two halo type polypoidal lesions changed to rosette and vascular network type. The lesions of three rosette and two vascular network type lesions did not change in shape. In addition, the size of the polypoidal lesions (one among two halo types, two among three rosette types, and two among two vascular network types) decreased, but one halo type did not change and one rosette type increased in size on OCTA. Conclusions En-face OCTA enabled us to categorize novel types of PCV with polypoidal lesions.
Collapse
Affiliation(s)
- San Seong
- Department of Ophthalmology, Nune Eye Hospital, Seoul, Korea
| | - Hun Goo Choo
- Department of Ophthalmology, Nune Eye Hospital, Seoul, Korea
| | - Yang Jae Kim
- Department of Ophthalmology, Nune Eye Hospital, Seoul, Korea
| | - Ju Young Kim
- Department of Ophthalmology, Nune Eye Hospital, Seoul, Korea
| | - Jin Hae Lee
- Department of Ophthalmology, Nune Eye Hospital, Seoul, Korea
| | - Hyun Sup Oh
- Department of Ophthalmology, Nune Eye Hospital, Seoul, Korea
| | - Yong Sung You
- Department of Ophthalmology, Nune Eye Hospital, Seoul, Korea
| | - Soon Hyun Kim
- Department of Ophthalmology, Nune Eye Hospital, Seoul, Korea
| | - Oh Woong Kwon
- Department of Ophthalmology, Nune Eye Hospital, Seoul, Korea.
| |
Collapse
|
11
|
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.
Collapse
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
| | | |
Collapse
|
12
|
Baek J, Lee JH, Jeon S, Lee WK. Choroidal morphology and short-term outcomes of combination photodynamic therapy in polypoidal choroidal vasculopathy. Eye (Lond) 2018; 33:419-427. [PMID: 30305706 DOI: 10.1038/s41433-018-0228-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 06/20/2018] [Accepted: 07/02/2018] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To investigate outcomes of combined photodynamic therapy (PDT) and intravitreal bevacizumab in association with choroidal morphology in polypoidal choroidal vasculopathy (PCV). METHOD Eighty-six PCV eyes (83 patients) treated with PDT in combination with intravitreal bevacizumab and followed for 1 year were evaluated. Choroidal morphological features including subfoveal choroidal thicknesses, diameter of pachyvessel, and choroidal vascularity were analyzed for association with responsiveness and recurrence. RESULT Total choroid, Haller's layer, and pachyvessel were thicker in responders (n = 70) compared with non-responders (n = 16) at baseline (298 vs. 227 μm, 213 vs. 144 μm, and 276 vs. 210 μm, respectively; all P ≤ 0.001). Choroidal vascularity was significantly higher (0.68 vs 0.60, P < 0.001) and choroidal hyperpermeability was more frequent in responders (44 vs 13%, P = 0.018). Significant thinning of total choroid was observed in both responders and non-responders at 3 months after combination PDT (both P < 0.05), but the reduction was greater in responders (- 33 μm vs. - 10 μm, P = 0.036). In recurrent eyes (n = 26), increase in pachyvessel diameter and choroidal vascularity was observed at recurrence. CONCLUSION Choroidal morphology including characteristic features of pachychoroid and high vascularity can serve as predictive factors for outcomes after combination PDT in eyes with PCV.
Collapse
Affiliation(s)
- Jiwon Baek
- Department of Ophthalmology and Visual Science, Bucheon St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Korea
| | - Jae Hyung Lee
- Department of Ophthalmology and Visual Science, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sohee Jeon
- Department of Ophthalmology and Visual Science, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won Ki Lee
- Department of Ophthalmology and Visual Science, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| |
Collapse
|
13
|
Long-term Progression and Risk Factors of Fundus Tessellation in the Beijing Eye Study. Sci Rep 2018; 8:10625. [PMID: 30006599 PMCID: PMC6045666 DOI: 10.1038/s41598-018-29009-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 06/28/2018] [Indexed: 12/12/2022] Open
Abstract
To assess the progression of fundus tessellation, color fundus photographs of the participants of the longitudinal population-based Beijing Eye Study were examined. The study included 4439 subjects in 2001 and 2695 (66.4% of the surviving) individuals in 2011. Larger progression in macular fundus tessellation (mean: 0.24 ± 0.48 grades) was associated (multivariate analysis; correlation coefficient r: 0.53) with thinner subfoveal choroidal thickness in 2011 (P < 0.001; standardized regression coefficient beta: −0.37), older age (P < 0.001; beta: 0.22), higher level of education (P < 0.001; beta: 0.09), more myopic change in refractive error (P < 0.001; beta: −0.09) and lower cognitive function score (P = 0.02; beta: −0.05). Larger increase in peripapillary fundus tessellation (mean: 0.19 ± 0.26 grades) correlated with thinner peripapillary choroidal thickness in 2011 (P < 0.001; beta: −0.35), older age (P < 0.001; beta: 0.20), worse best corrected visual acuity (P = 0.001; beta: 0.07), more myopic change in refractive error (P < 0.001; beta: −0.07) and higher prevalence of ever smoking (P = 0.004; beta: 0.05). The increase in macular fundus tessellation, as a surrogate for thinning of the posterior choroid, was associated with lower cognitive function, after adjusting for choroidal thickness, age, educational level and change in refractive error. The findings point to the clinical value of the assessment of fundus tessellation and suggest potential associations between cognitive function and fundus tessellation/choroidal thickness.
Collapse
|
14
|
Characteristic appearances of fundus autofluorescence in treatment-naive and active polypoidal choroidal vasculopathy: a retrospective study of 170 patients. Graefes Arch Clin Exp Ophthalmol 2018; 256:1101-1110. [DOI: 10.1007/s00417-018-3980-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/28/2018] [Accepted: 04/05/2018] [Indexed: 10/17/2022] Open
|
15
|
Baek J, Lee JH, Lee WK. CLINICAL RELEVANCE OF AQUEOUS VASCULAR ENDOTHELIAL GROWTH FACTOR LEVELS IN POLYPOIDAL CHOROIDAL VASCULOPATHY. Retina 2017; 37:943-950. [PMID: 27617539 DOI: 10.1097/iae.0000000000001284] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate vascular endothelial growth factor (VEGF) level according to the clinical and imaging features, and to explore its relationship with the responsiveness to anti-VEGF treatment in eyes with polypoidal choroidal vasculopathy. METHODS Aqueous samples were collected from 62 eyes of 62 patients with treatment-naïve polypoidal choroidal vasculopathy. Vascular endothelial growth factor levels were measured using enzyme-linked immunosorbent assay. Baseline best-corrected visual acuity, central macular thickness, subfoveal choroidal thickness, greatest linear dimension of the lesion, and the presence of hemorrhage were included in the analysis. The effects of 3 monthly intravitreal ranibizumab injections on best-corrected visual acuity and central macular thickness were assessed. RESULTS Baseline VEGF level was negatively correlated with subfoveal choroidal thickness (r = -0.33, P = 0.01). Other variables had no correlation with VEGF level. The mean change in central macular thickness after anti-VEGF treatment was -51 ± 64 μm, which is positively correlated with VEGF concentration (r = 0.30, P = 0.04) and negatively correlated with subfoveal choroidal thickness (r = -0.35, P = 0.02). CONCLUSION Vascular endothelial growth factor level demonstrated a negative correlation with baseline subfoveal choroidal thickness and was associated with response to anti-VEGF treatment. These findings suggest that VEGF has a variable contribution to the pathogenesis of polypoidal choroidal vasculopathy depending on choroid thickness.
Collapse
Affiliation(s)
- Jiwon Baek
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | | | | |
Collapse
|
16
|
MORPHOLOGIC FEATURES ASSOCIATED WITH FIBROTIC SCARRING AFTER ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY IN POLYPOIDAL CHOROIDAL VASCULOPATHY. Retina 2017; 38:2168-2176. [PMID: 28930802 DOI: 10.1097/iae.0000000000001845] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate morphologic features associated with fibrotic scarring after anti-vascular endothelial growth factor therapy in polypoidal choroidal vasculopathy (PCV). METHODS This retrospective study included 293 patients who had been diagnosed with PCV and treated with anti-vascular endothelial growth factor monotherapy during a 12-month follow-up period. Associations of morphologic features, including type of PCV, location of the polypoidal lesion, greatest linear dimension, largest polyp diameter, choroidal vascular hyperpermeability, pigment epithelial detachment, intraretinal fluid, and subretinal hyperreflective material (SHRM) with fibrotic scar at 12 months were analyzed. RESULTS Fibrotic scars were noted in 15 eyes (5.1%). The incidence of fibrotic scars was higher in Type 1 PCV (8 of 76 eyes) than in Type 2 PCV (7 of 217 eyes, P = 0.028). The incidence was also higher in eyes with SHRM (14 of 124 eyes) than in eyes without SHRM (1 of 169 eyes, P < 0.001). In multivariate analysis, SHRM was associated with fibrotic scar (P = 0.005). Among the SHRM cases, the incidence of the scar was 12.9% in eyes with submacular hemorrhage and 8.5% in eyes without hemorrhage. CONCLUSION Although fibrotic scar is an infrequent finding in PCV, the possibility of scarring should be considered in eyes with SHRM, particularly in submacular hemorrhage cases.
Collapse
|
17
|
Submacular hemorrhage and grape-like polyp clusters: factors associated with reactivation of the lesion in polypoidal choroidal vasculopathy. Eye (Lond) 2017; 31:1678-1684. [PMID: 28707675 DOI: 10.1038/eye.2017.126] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/10/2017] [Indexed: 01/01/2023] Open
Abstract
PurposeThe purpose of this study is to investigate the factors associated with reactivation of the lesion during the first year in patients with polypoidal choroidal vasculopathy (PCV) treated with intravitreal ranibizumab.Patients and methodsThis retrospective observational study included 84 eyes diagnosed with PCV and treated with 3-monthly ranibizumab injections. Only those patients who exhibited complete resolution of fluid after initial treatment and were followed up at least 12 months were included. The baseline characteristics of the patients, including their age and sex, location of the polyps, greatest linear dimensions of the lesions, largest polyp diameter, choroidal vascular hyperpermeability, submacular hemorrhages ≥1 disc area in size, presence of grape-like polyp clusters, central foveal thickness, and best-corrected visual acuity were compared between patients with and without reactivation of the lesion.ResultsDuring the 12-month follow-up period, reactivation of the lesion was observed in 60 patients (71.4%). The first reactivation was noted at a mean duration of 3.9±1.7 months after the third ranibizumab injection. Cox regression analysis revealed that the absence of submacular hemorrhages ≥1 disc area (P=0.009), presence of grape-like polyp clusters (P=0.002), and greatest linear dimension of the lesions (P=0.019) were associated with reactivation of the lesion.ConclusionThe absence of submacular hemorrhages, presence of grape-like polyp clusters, and large lesion size at diagnosis were associated with a high risk of reactivation of PCV in patients treated with intravitreal ranibizumab. Patients exhibiting these characteristics may require close monitoring.
Collapse
|
18
|
Alasil T, Munoz N, Keane PA, Tufail A, Coady PA, Novais E, de Carlo TE, Baumal CR, Waheed NK, Duker JS, Adelman RA. Characteristics and racial variations of polypoidal choroidal vasculopathy in tertiary centers in the United States and United Kingdom. Int J Retina Vitreous 2017; 3:9. [PMID: 28428893 PMCID: PMC5392942 DOI: 10.1186/s40942-017-0060-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/17/2017] [Indexed: 01/01/2023] Open
Abstract
Purpose To evaluate the characteristics and racial variations amongst patients with polypoidal choroidal vasculopathy (PCV) in the United States and the United Kingdom. Methods Fundus photos and indocyanine green angiography images were evaluated in a multicenter retrospective study to establish the diagnosis of PCV. Visual acuity (VA) was recorded in ETDRS letter count. Results Eighty eyes of 71 PCV patients (average age of 69.4 ± 10.4 years) were included in the analysis. Of the total 71 subjects, 46 (65%) were women, 33 (46.5%) were Blacks, 16 (22.5%) were Whites, 19 (26.8%) were Asians and 3 (4.2%) belonged to other races. The Black subgroup had vision gain of 3.5 letters. The White and Asian subgroups had vision loss of 13.1 and 3.5 letters, respectively. There was female predominance in Blacks (67%), Whites (69%), and Asians (58%). PCV was found to be a bilateral disease in 14 patients (20%). There was significant decrease of 7 letters with every decade increase in age (p = 0.005). Final VA was worse in males when compared to females (p = 0.042), and worse in Whites when compared to Blacks (p = 0.005). For every 10 letters worse in initial VA upon diagnosis with PCV, the final VA was worse by 6 letters (p < 0.001). The location of the polypoidal lesion within the macula was associated with significant decrease of 14 letters in BCVA (p = 0.02). The length of follow up was significantly associated with worse visual outcome (p = 0.012). Final VA had no significant correlation with the lens status, or the different treatment modalities. Conclusions Based on our cohort from tertiary centers in the United States and United Kingdom, PCV is a bilateral disease in one-fifth of patients. It features a variable female predominance based on ethnicity. Increased age, worse vision upon initial presentation, longer follow up and macular location of the polyp were associated with worse visual outcome. Electronic supplementary material The online version of this article (doi:10.1186/s40942-017-0060-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tarek Alasil
- Department of Ophthalmology and Visual Sciences, School of Medicine, Yale University, New Haven, CT USA
| | - Nelida Munoz
- Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - Pearse A Keane
- Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - Adnan Tufail
- Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - Patrick A Coady
- Department of Ophthalmology and Visual Sciences, School of Medicine, Yale University, New Haven, CT USA
| | - Eduardo Novais
- New England Eye Center, Tufts Medical Center, Boston, MA USA.,School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | | | | | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, MA USA
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, MA USA
| | - Ron A Adelman
- Department of Ophthalmology and Visual Sciences, School of Medicine, Yale University, New Haven, CT USA
| |
Collapse
|
19
|
CHOROIDAL MORPHOLOGY IN EYES WITH POLYPOIDAL CHOROIDAL VASCULOPATHY AND NORMAL OR SUBNORMAL SUBFOVEAL CHOROIDAL THICKNESS. Retina 2017; 36 Suppl 1:S73-S82. [PMID: 28005665 DOI: 10.1097/iae.0000000000001346] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To subsegment the choroid in patients with polypoidal choroidal vasculopathy and to determine whether the ratio of choriocapillaris/Sattler layer thickness to total choroidal thickness is decreased at sites of polypoidal pathology. METHODS Retrospective, observational, cross-sectional study. A total of 320 eyes of 305 patients with polypoidal choroidal vasculopathy were studied with optical coherence tomography and dye angiography. The ratio of choriocapillaris/Sattler layer thickness to total choroidal thickness was calculated at polypoidal lesion sites in eyes with subfoveal choroidal thickness (SFCT) ≤200 μm. RESULTS Mean SFCT was 267.7 ± 118.5 μm for the entire cohort. Mean SFCT was 151.2 ± 35.0 μm in eyes with SFCT ≤200 μm (n = 124, 39%). In this subgroup, dilated Haller vessels (pachyvessels) were identified under the site of neovascular ingrowth in 117 eyes (94%). Choroidal thickness in the pachyvessel zone was greater (213.3 ± 52.2 μm) than SFCT (P < 0.001) with a significantly lower choriocapillaris/Sattler layer to total thickness ratio (P < 0.001). Qualitative alterations of the retinal pigment epithelium were observed in 60 eyes (51%). CONCLUSION Eyes with normal or subnormal SFCT exhibited extrafoveal choroidal thickening at sites of polypoidal disease. The choriocapillaris and Sattler layers were attenuated at these locations, but Haller vessels were markedly dilated. These changes were topographically associated with sites of neovascular ingrowth and support the classification of polypoidal choroidal vasculopathy as a pachychoroid disorder.
Collapse
|
20
|
DISTINGUISHING POLYPOIDAL CHOROIDAL VASCULOPATHY FROM TYPICAL NEOVASCULAR AGE-RELATED MACULAR DEGENERATION BASED ON SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY. Retina 2016; 36:778-86. [PMID: 26428604 DOI: 10.1097/iae.0000000000000794] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the sensitivity and specificity of spectral domain optical coherence tomography in distinguishing polypoidal choroidal vasculopathy (PCV) from typical neovascular age-related macular degeneration (nAMD). METHODS One hundred and eighty-eight eyes in 156 patients with active PCV or typical nAMD were enrolled prospectively. Three spectral domain optical coherence tomography manifestations, pigment epithelium detachment, double-layer sign, and thumb-like polyps were estimated in all the eyes. A diagnostic test to differentiate PCV from nAMD based on spectral domain optical coherence tomography was performed. Furthermore, the sensitivity and specificity was validated in a retrospective series of patients. RESULTS Pigment epithelium detachment, double-layer sign, and thumb-like polyps were more common in PCV eyes than in nAMD eyes. When the cutoff point was set as at least 2 positive signs out of 3 in the diagnostic test, the sensitivity was 89.4% and specificity was 85.3%. The results of the validation test further confirmed the strategy, with satisfying sensitivity (87.5%) and specificity (86.2%). CONCLUSION Spectral domain optical coherence tomography is sensitive and specific in distinguishing PCV from nAMD. From these results, the presence of at least two out three signs (pigment epithelium detachment, double-layer sign, and thumb-like polyps) indicates a positive test and is therefore suggested to be the screening strategy for PCV.
Collapse
|
21
|
Hikichi T, Kitamei H, Shioya S. Retinal pigment epithelial atrophy over polypoidal choroidal vasculopathy lesions during ranibizumab monotherapy. BMC Ophthalmol 2016; 16:55. [PMID: 27184489 PMCID: PMC4868043 DOI: 10.1186/s12886-016-0237-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/11/2016] [Indexed: 01/23/2023] Open
Abstract
Background To evaluate the quantitative changes of retinal pigment epithelial (RPE) atrophy during 3-year follow-up period of ranibizumab monotherapy for polypoidal choroidal vasculopathy (PCV). Methods We retrospectively reviewed consecutive 100 Japanese patients with unilateral symptomatic treatment-naïve PCV who received ranibizumab monotherapy for 3 years. Color fundus photography, spectral-domain optical coherence tomography, and fundus autofluorescence were evaluated for RPE atrophy. Multiple regression analysis was performed to investigate the predictive factors found during univariate analysis to identify an association with increased RPE atrophic areas. RPE atrophic areas overlapping PCV lesions were measured. Results The mean (standard deviation) number of injections was 11.4 (4.50). RPE atrophic area enlarged to 2.91 (5.41 mm2) 3 years after the first injection from 1.22 (1.72 mm2) at baseline, which differed significantly (P = 0.012). Multiple regression analysis showed that larger PCV lesions and larger RPE atrophic areas at baseline were associated with increased RPE atrophic areas. RPE atrophic area overlapping the baseline PCV lesions significantly increased during 3-year follow-up period, whereas RPE atrophic area not overlapping the baseline PCV lesions did not increase significantly. Conclusion RPE atrophy progresses in eyes with PCV during ranibizumab monotherapy and the tendency for development of RPE atrophy within the PCV lesions.
Collapse
Affiliation(s)
- Taiichi Hikichi
- Hikichi Eye Clinic, Kita-7 Nishi-5 7-1 Kita-Sky-Bild 14F, Kita-ku, Sapporo, 060-0807, Japan. .,Ohtsuka Eye Hospital, Sapporo, Japan.
| | | | | |
Collapse
|
22
|
张 怡, 姚 静, 王 肖, 赵 琳, 王 丽, 王 建, 周 爱. [Sensitivity and specificity of optical coherence tomography in diagnosing polypoidal choroidal vasculopathy]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2016; 37:165-171. [PMID: 28219858 PMCID: PMC6779675 DOI: 10.3969/j.issn.1673-4254.2017.02.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To establish the diagnostic criteria for polypoidal choroidal vasculopathy (PCV) based on spectral-domain optical coherence tomography (SD OCT) by evaluating the sensitivity and specificity of SD OCT in differentiating PCV from wet age-related macular degeneration (wAMD). METHODS The clinical data were reviewed for 62 patients (63 eyes) with the initial diagnosis of PCV or wAMD between August, 2012 and June, 2016. Twenty-four patients (25 eyes) were diagnosed to have PCV and 38 (38 eyes) had wAMD based on findings by fundus photography, fluorescein angiography (FFA) and indocyanine green angiography (ICGA). Among the 6 features of SD OCT, namely a sharp RPED peak, double-layer sign, multiple RPED, an RPED notch, a hyporeflective lumen representing polyps, and hyperreflective intraretinal hard exudates, findings of the first two features and at least one of the other features sufficed the diagnosis of PCV; in the absence of the first two features, the diagnosis of PCV was also made when at least 3 of the other features were present simultaneously. The sensitivity and specificity of SD OCT-based diagnosis were estimated by comparison with the gold standard ICGA-based diagnosis. RESULTS In the 25 eyes with an established diagnosis of PCV, 23 eyes (92.0%) met the diagnostic criteria based on SD OCT findings; in the 38 eyes with the diagnosis of wAMD, only 4 eyes (10.5%) met the criteria. The sensitivity and specificity of SD OCT-based diagnosis of PCV was 92.0% and 89.5%, respectively. CONCLUSION s We established the diagnostic criteria for PCV based on SD OCT findings with a high sensitivity and specificity. SD OCT shows a strong capacity for differentiating PCV from wAMD.
Collapse
Affiliation(s)
- 怡 张
- />西安交通大学第二附属医院眼科, 陕西 西安 710004Department of Ophthalmology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - 静 姚
- />西安交通大学第二附属医院眼科, 陕西 西安 710004Department of Ophthalmology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - 肖华 王
- />西安交通大学第二附属医院眼科, 陕西 西安 710004Department of Ophthalmology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - 琳 赵
- />西安交通大学第二附属医院眼科, 陕西 西安 710004Department of Ophthalmology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - 丽君 王
- />西安交通大学第二附属医院眼科, 陕西 西安 710004Department of Ophthalmology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - 建明 王
- />西安交通大学第二附属医院眼科, 陕西 西安 710004Department of Ophthalmology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - 爱意 周
- />西安交通大学第二附属医院眼科, 陕西 西安 710004Department of Ophthalmology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| |
Collapse
|
23
|
Kim JY, Kwon OW, Oh HS, Kim SH, You YS. Optical coherence tomography angiography in patients with polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 2015; 254:1505-1510. [DOI: 10.1007/s00417-015-3228-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/09/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022] Open
|
24
|
Semoun O, Coscas F, Coscas G, Lalloum F, Srour M, Souied EH. En face enhanced depth imaging optical coherence tomography of polypoidal choroidal vasculopathy. Br J Ophthalmol 2015; 100:1028-34. [PMID: 26541431 DOI: 10.1136/bjophthalmol-2015-307494] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 10/15/2015] [Indexed: 11/03/2022]
Abstract
PURPOSE To analyse retinal and choroidal changes associated with polypoidal choroidal vasculopathy (PCV) using en face spectral-domain optical coherence tomography (SD-OCT). METHODS In this retrospective and descriptive study, we collected imaging of patients affected with PCV examined using enhanced depth imaging (EDI) SD-OCT, fluorescein and indocyanine green angiography for a qualitative analysis. The three-dimensional reconstruction of 197 transverse sections with EDI SD-OCT at 30 μm intervals provided a virtual macular brick through which 496 sections in the coronal plane resulted in a C-scan or en face OCT image. RESULTS 30 eyes of 30 patients affected with PCV were studied. En face OCT revealed polyps as roundish structures visible deeper than pigment epithelium layer, attached to its posterior face, easily detected in all cases. Hyper-reflective dots were visible on en face OCT in all cases within the retinal layers, associated to a well-defined dark area suggesting serous exudation in 27 eyes. The abnormal choroidal network was identified in four eyes. At the Bruch membrane level, all polyps were associated with a localised back shadowing, and were no more visible at the choriocapillaris layer level. Large choroidal vessels were visible in all eyes, mainly at the polypoidal lesion periphery, not directly behind. CONCLUSIONS En face OCT imaging using SD-OCT is an easy, reproducible, non-invasive and effective tool to visualise and to understand retinal and choroidal changes PCV. It provides complementary morphological information, describes new semiological entities and might substitute other exams in the future, without dye injection.
Collapse
Affiliation(s)
- Oudy Semoun
- University Eye Clinic of Créteil, Centre Hospitalier Intercommunal de Créteil, Paris, France
| | - Florence Coscas
- University Eye Clinic of Créteil, Centre Hospitalier Intercommunal de Créteil, Paris, France Centre d'exploration Ophtalmologique de l'Odéon, Paris, France
| | - Gabriel Coscas
- University Eye Clinic of Créteil, Centre Hospitalier Intercommunal de Créteil, Paris, France Centre d'exploration Ophtalmologique de l'Odéon, Paris, France
| | - Franck Lalloum
- University Eye Clinic of Créteil, Centre Hospitalier Intercommunal de Créteil, Paris, France
| | - Mayer Srour
- University Eye Clinic of Créteil, Centre Hospitalier Intercommunal de Créteil, Paris, France
| | - Eric H Souied
- University Eye Clinic of Créteil, Centre Hospitalier Intercommunal de Créteil, Paris, France
| |
Collapse
|
25
|
Ferrara D, Waheed NK, Duker JS. Investigating the choriocapillaris and choroidal vasculature with new optical coherence tomography technologies. Prog Retin Eye Res 2015; 52:130-55. [PMID: 26478514 DOI: 10.1016/j.preteyeres.2015.10.002] [Citation(s) in RCA: 192] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/09/2015] [Accepted: 10/12/2015] [Indexed: 02/06/2023]
Abstract
The body of knowledge of in vivo investigation of the choroid has been markedly enhanced by recent technological advances in optical coherence tomography (OCT). New insights elucidating the morphological features of the choriocapillaris and choroidal vasculature, in both physiological and pathological conditions, indicate that the choroid plays a pivotal role in many posterior segment diseases. In this article, a review of the histological characteristics of the choroid, which must be considered for the proper interpretation of in vivo imaging, is followed by a comprehensive discussion of fundamental principles of the current state-of-the-art in OCT, including cross-sectional OCT, en face OCT, and OCT angiography using both spectral domain OCT and swept source OCT technologies. A detailed review of the tomographic features of the choroid in the normal eye is followed by relevant findings in prevalent chorioretinal diseases, focusing on major causes of vision loss such as typical early and advanced age-related macular degeneration, polypoidal choroidal vasculopathy, central serous chorioretinopathy, pachychoroid spectrum disorders, diabetic choroidopathy, and myopia.
Collapse
Affiliation(s)
- Daniela Ferrara
- New England Eye Center, Tufts University School of Medicine, 260 Tremont Street, 10th Floor, Boston, MA, USA.
| | - Nadia K Waheed
- New England Eye Center, Tufts University School of Medicine, 260 Tremont Street, 10th Floor, Boston, MA, USA
| | - Jay S Duker
- New England Eye Center, Tufts University School of Medicine, 260 Tremont Street, 10th Floor, Boston, MA, USA
| |
Collapse
|
26
|
Ting DSW, Cheung GCM, Lim LS, Yeo IYS. Comparison of swept source optical coherence tomography and spectral domain optical coherence tomography in polypoidal choroidal vasculopathy. Clin Exp Ophthalmol 2015; 43:815-9. [DOI: 10.1111/ceo.12580] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 06/14/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Daniel SW Ting
- Singapore National Eye Center; Singapore Health Service (SingHealth); Singapore Singapore
| | - Gemmy CM Cheung
- Singapore National Eye Center; Singapore Health Service (SingHealth); Singapore Singapore
| | - Laurence S Lim
- Singapore National Eye Center; Singapore Health Service (SingHealth); Singapore Singapore
| | - Ian YS Yeo
- Singapore National Eye Center; Singapore Health Service (SingHealth); Singapore Singapore
| |
Collapse
|
27
|
IMPROVED SPECIFICITY OF POLYPOIDAL CHOROIDAL VASCULOPATHY DIAGNOSIS USING A MODIFIED EVEREST CRITERIA. Retina 2015; 35:1375-80. [DOI: 10.1097/iae.0000000000000482] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
28
|
CHOROIDAL NEOVASCULARIZATION IN CAUCASIAN PATIENTS WITH LONGSTANDING CENTRAL SEROUS CHORIORETINOPATHY. Retina 2015; 35:1360-7. [DOI: 10.1097/iae.0000000000000529] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
29
|
Alasil T, Ferrara D, Adhi M, Brewer E, Kraus MF, Baumal CR, Hornegger J, Fujimoto JG, Witkin AJ, Reichel E, Duker JS, Waheed NK. En face imaging of the choroid in polypoidal choroidal vasculopathy using swept-source optical coherence tomography. Am J Ophthalmol 2015; 159:634-43. [PMID: 25528955 DOI: 10.1016/j.ajo.2014.12.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 12/12/2014] [Accepted: 12/12/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To define morphologic features of polypoidal choroidal vasculopathy (PCV) using en face images from swept-source optical coherence tomography (SS OCT). DESIGN Prospective cross-sectional study. METHODS The study included 10 eyes from 6 patients with PCV and 10 eyes from 5 age-matched normal subjects. All subjects were prospectively scanned with a prototype SS OCT system. A motion correction algorithm was applied to correct and merge scans into a single volumetric dataset. En face images were generated at intervals of 4.13 μm (1 pixel) relative to the Bruch membrane. RESULTS Age ± standard deviation for the normal group was 62.4 (±12.1) years and for the PCV group was 68.3 (±5.2) years. En face SS OCT imaging of PCV eyes demonstrated the relationship between larger pigment epithelial detachments (PEDs) and small adjoining PEDs that correlated with the polypoidal lesions seen on indocyanine green angiography in all PCV eyes. En face SS OCT demonstrated choroidal vascular abnormalities in 7 out of 7 eyes with PCV, and in 2 out of 3 enrolled fellow eyes in patients with unilateral PCV. Out of 7 PCV eyes, focal choroidal vascular dilation was noted in 3 eyes and diffuse choroidal vascular dilation was noted in 1 eye. In addition, a branching vascular network was noted above the Bruch membrane in 1 eye, below the Bruch membrane within the choriocapillaris in 1 eye, and in the larger choroidal vascular layer in 1 eye. CONCLUSIONS En face SS OCT provides an in vivo tool to visualize the pathologic features and the choroidal vasculature in PCV.
Collapse
Affiliation(s)
- Tarek Alasil
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Daniela Ferrara
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Mehreen Adhi
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Erika Brewer
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Martin F Kraus
- Pattern Recognition Lab and School of Advanced Optical Technologies, University Erlangen Nuremberg, Erlangen, Germany; Departments of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | | | - Joachim Hornegger
- Pattern Recognition Lab and School of Advanced Optical Technologies, University Erlangen Nuremberg, Erlangen, Germany
| | - James G Fujimoto
- Departments of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Andre J Witkin
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Elias Reichel
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts.
| |
Collapse
|
30
|
Hikichi T, Kitamei H, Shioya S. Prognostic factors of 2-year outcomes of ranibizumab therapy for polypoidal choroidal vasculopathy. Br J Ophthalmol 2014; 99:817-22. [PMID: 25480464 DOI: 10.1136/bjophthalmol-2014-305606] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 11/19/2014] [Indexed: 11/04/2022]
Abstract
PURPOSE To determine predictors of 2-year outcomes after three, monthly, intravitreal ranibizumab (IVR) injections followed by as-needed injections for treatment-naive polypoidal choroidal vasculopathy (PCV). METHODS This trial included 85 Japanese patients with symptomatic treatment-naive PCV who received one 0.5 mg IVR injection monthly for 3 months followed by as-needed retreatments. PCV with subfoveal leakage on fluorescein angiography with or without actual choroidal neovascularisation were included. Analyses evaluated independent baseline predictors of better and improved visual acuity (VA) and need for fewer reinjections 2 years after the first injection. RESULTS After the three monthly injections, 1.3±1.4 and 1.5±2.0 (mean±SD) as-needed injections were administered during years 1 and 2, respectively. The baseline logarithm of the minimum angle of resolution, VA (0.60±0.49) improved significantly (p=0.001) (0.41±0.47) 2 years after the first injection. Younger patients' eyes with a better baseline VA and no cluster of grape-like polypoidal lesions were significant independent predictors of better VA 2 years after treatment. No baseline factors predicted fewer ranibizumab reinjections during 2 years. At 2 years, resolution of polypoidal lesions 1 month after the three monthly injections did not affect VA and number of reinjections during 2 years. CONCLUSIONS Patient age, baseline VA and clusters of grape-like polypoidal lesions predicted VA outcomes 2 years after treatment with IVR for PCV.
Collapse
Affiliation(s)
- Taiichi Hikichi
- Department of Ophthalmology, Ohtsuka Eye Hospital, Sapporo, Japan
| | - Hirokuni Kitamei
- Department of Ophthalmology, Ohtsuka Eye Hospital, Sapporo, Japan
| | - Shoko Shioya
- Department of Ophthalmology, Ohtsuka Eye Hospital, Sapporo, Japan
| |
Collapse
|
31
|
De Salvo G, Vaz-Pereira S, Keane PA, Tufail A, Liew G. Sensitivity and specificity of spectral-domain optical coherence tomography in detecting idiopathic polypoidal choroidal vasculopathy. Am J Ophthalmol 2014; 158:1228-1238.e1. [PMID: 25152500 DOI: 10.1016/j.ajo.2014.08.025] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 08/16/2014] [Accepted: 08/18/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the efficacy of spectral-domain optical coherence tomography (SD OCT) compared to indocyanine green angiography (ICGA) in detecting idiopathic polypoidal choroidal vasculopathy (PCV) and in differentiating between PCV and occult choroidal neovascularization (CNV). DESIGN Retrospective observational case-control study. METHODS SD OCTs of 51 eyes of 44 consecutive patients who presented with 1 or more pigment epithelial detachments (PEDs) attributable to either PCV or occult CNV were retrospectively reviewed by a grader masked to the final diagnosis. A qualitative analysis based on the following tomographic findings was performed: sharp PED peak, PED notch, hyporeflective lumen within hyperreflective lesions adherent to retinal pigment epithelium. The diagnosis based on SD OCT alone was compared with the final diagnosis made using ICGA and fluorescein angiography. Sensitivity and specificity were calculated. Patients with classic CNV and central serous chorioretinopathy were excluded. RESULTS Among 51 eyes of 44 patients, 37 had an ICGA-confirmed diagnosis of PCV and 14 had occult CNV. SD OCT based on the features above detected 35 of 37 true-positive PCV lesions but missed 2 ICGA-confirmed lesions (false negatives). SD OCT correctly excluded 13 of 14 non-PCV lesions but misidentified 1 PCV lesion (false positive). These data showed a sensitivity of 94.6% and a specificity of 92.9% for the above SD OCT features in identifying PCV lesions. CONCLUSIONS SD OCT based on the features above allowed for good detection of PCV and differentiation between PCV and occult CNV in this selected clinic population. A careful qualitative analysis of the tomographic findings in patients presenting with PEDs may allow ophthalmologists to distinguish between PCV and occult CNV, decreasing the need for ICGA and the risks related to this procedure.
Collapse
Affiliation(s)
- Gabriella De Salvo
- Medical Retina Department, Moorfields Eye Hospital National Health Service Foundation Trust; and National Institute of Health Research Biomedical Research Centre at Moorfields Eye Hospital National Health System Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom.
| | - Sara Vaz-Pereira
- Medical Retina Department, Moorfields Eye Hospital National Health Service Foundation Trust; and National Institute of Health Research Biomedical Research Centre at Moorfields Eye Hospital National Health System Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
| | - Pearse A Keane
- Medical Retina Department, Moorfields Eye Hospital National Health Service Foundation Trust; and National Institute of Health Research Biomedical Research Centre at Moorfields Eye Hospital National Health System Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
| | - Adnan Tufail
- Medical Retina Department, Moorfields Eye Hospital National Health Service Foundation Trust; and National Institute of Health Research Biomedical Research Centre at Moorfields Eye Hospital National Health System Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
| | - Gerald Liew
- Medical Retina Department, Moorfields Eye Hospital National Health Service Foundation Trust; and National Institute of Health Research Biomedical Research Centre at Moorfields Eye Hospital National Health System Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
| |
Collapse
|
32
|
Sayanagi K, Gomi F, Akiba M, Sawa M, Hara C, Nishida K. En-face high-penetration optical coherence tomography imaging in polypoidal choroidal vasculopathy. Br J Ophthalmol 2014; 99:29-35. [DOI: 10.1136/bjophthalmol-2013-304658] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
33
|
Yamagishi T, Koizumi H, Yamazaki T, Kinoshita S. Changes in fundus autofluorescence after treatments for polypoidal choroidal vasculopathy. Br J Ophthalmol 2014; 98:780-4. [PMID: 24515988 DOI: 10.1136/bjophthalmol-2013-303739] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To evaluate changes in fundus autofluorescence (FAF) after treatments for polypoidal choroidal vasculopathy (PCV). METHODS Thirty-six eyes of 35 patients with treatment-naive PCV underwent intravitreal injection of ranibizumab, photodynamic therapy, or a combination of both treatments. FAF and indocyanine green angiography (ICGA) at baseline were compared with those obtained 12 months later about the changes at the affected lesion. RESULTS In the 36 eyes, 88 polyps were detected on ICGA at baseline, and 65 (73.9%) of those showed centred hypoautofluorescence and a circumferential hyperautofluorescent ring on FAF. Twelve months later, ICGA revealed resolution of 42 of those 65 polyps. Of those 42 resolved polyps, 30 hyperautofluorescent rings (71.4%) were eliminated concurrently with the resolution of polyp. Statistical analysis revealed that an elimination of the hyperautofluorescent ring was more frequently observed in association with the resolved polyps than with the persistent polyps (p<0.0001). All the hypoautofluorescent findings corresponding to branching vascular networks at baseline were unchanged during the follow-up period. CONCLUSIONS Elimination of the hyperautofluorescent ring is highly associated with the resolution of the polyp on ICGA. We propose that FAF has a potential as a non-invasive method of evaluating the therapeutic efficacy of treatments for PCV.
Collapse
Affiliation(s)
- Tetsuya Yamagishi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hideki Koizumi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Taizo Yamazaki
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shigeru Kinoshita
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
34
|
Abstract
PURPOSE To assess the dimensions of hyporeflective choroidal lumina and choroidal thickness in patients with polypoidal choroidal vasculopathy (PCV) without subretinal hemorrhage. METHODS Chinese patients with PCV and without subretinal hemorrhage and subjects of a control group underwent enhanced depth imaging by optical coherence tomography. Choroidal thickness and the largest diameter of choroidal hyporeflective lumina as surrogates for choroidal vessels were measured. RESULTS The study included 18 eyes of Chinese patients with PCV and 19 subjects of a control group, with no significant difference in age (P = 0.10) or refractive error (P = 0.89) between the groups. Mean subfoveal choroidal thickness was significantly higher in the study group than in the control group (338 ± 107 μm vs. 261 ± 78 μm; P = 0.017), and mean largest diameter of the choroidal vessels was significantly larger in the study group than in the control group (236 ± 63 μm vs. 137 ± 48 μm; P < 0.001). Choroidal thickness was significantly (P < 0.001) correlated with the largest choroidal vessel diameter. In the area of the branching choroidal vascular networks in PCV eyes, a "double-layer sign" with two highly reflective layers was noted with an undulating retinal pigment epithelial line, a hyperreflective straight line representing Bruch membrane, and a moderate hyperreflectivity between these two lines. Bruch membrane appeared to be intact. In 4 eyes (22%), a dome-shaped retinal pigment epithelial elevation was detected. It correlated spatially with the polypoidal lesions. CONCLUSION Polypoidal choroidal vasculopathy is characterized by a thickened subfoveal choroid with dilated choroidal vessels, a double-layer sign at the level of the retinal pigment epithelium-Bruch membrane-choriocapillaris complex, and hyperreflectivity between the retinal pigment epithelium and Bruch membrane. Choroidal macular swelling in PCV is mainly associated with vascular engorgement and dilatation.
Collapse
|
35
|
Kim JH, Kang SW, Kim TH, Kim SJ, Ahn J. Structure of polypoidal choroidal vasculopathy studied by colocalization between tomographic and angiographic lesions. Am J Ophthalmol 2013; 156:974-980.e2. [PMID: 23958701 DOI: 10.1016/j.ajo.2013.06.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 06/07/2013] [Accepted: 06/07/2013] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate the structure of polypoidal choroidal vasculopathy (PCV) by tomographic localization of the branching vascular network and late geographic hyperfluorescence. DESIGN Observational case series. METHODS We examined 34 eyes with PCV by simultaneous indocyanine green angiography (ICGA) and spectral-domain optical coherence tomography (OCT) imaging. The margin of the branching vascular network and the late geographic hyperfluorescence on ICGA was colocalized on OCT, in a point-to-point manner, using innate software. The large vessels within the branching vascular network were also colocalized on OCT. RESULTS Late geographic hyperfluorescence on ICGA was noted in 30 eyes. The extent of late geographic hyperfluorescence was larger than that of branching vascular network in 12 eyes. In the remaining eyes, the extent was the same. A double-layer sign on OCT, which consisted of two hyper-reflective lines, representing the retinal pigment epithelium and Bruch membrane, was noted in 29 eyes. In all 28 eyes exhibiting both late geographic hyperfluorescence and the double-layer sign, the extent of late geographic hyperfluorescence matched exactly the extent of double-layer sign on OCT. In 7 of 34 eyes, the thickness of the subretinal pigment epithelial space over the Bruch membrane was too thin to accommodate the large vessels of the branching vascular network. Although the double-layer sign showed mild reduction in area after photodynamic therapy, its general configuration was maintained. CONCLUSIONS Late geographic hyperfluorescence on ICGA corresponds with the double-layer sign on OCT in eyes with PCV. Our observations suggest that the double-layer sign consists mainly of fibrous tissue harbored by the branching vascular network, and late geographic hyperfluorescence may originate from the staining of tissue.
Collapse
Affiliation(s)
- Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, South Korea
| | | | | | | | | |
Collapse
|
36
|
Polypoidal choroidal vasculopathy: evidence-based guidelines for clinical diagnosis and treatment. Retina 2013; 33:686-716. [PMID: 23455233 DOI: 10.1097/iae.0b013e3182852446] [Citation(s) in RCA: 194] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Polypoidal choroidal vasculopathy (PCV) is an exudative maculopathy affecting vision, with clinical features distinct from neovascular age-related macular degeneration. Currently, no evidence-based guidelines exist for its diagnosis and treatment. METHODS A panel of experts analyzed a systematic literature search on PCV together with results of the EVEREST trial, the only published randomized controlled clinical trial in PCV. At a subsequent Roundtable meeting, recommendations for the management of PCV were agreed based on this analysis and their own expert opinion. RESULTS Diagnosis of PCV should be based on early-phase nodular hyperfluorescence from choroidal vasculature visualized using indocyanine green angiography. Recommended initial treatment of juxtafoveal and subfoveal PCV is either indocyanine green angiography-guided verteporfin photodynamic therapy or verteporfin photodynamic therapy plus 3 × 0.5 mg ranibizumab intravitreal injections 1 month apart. If there is incomplete regression of polyps by indocyanine green angiography, eyes should be retreated with verteporfin photodynamic therapy monotherapy or verteporfin photodynamic therapy plus ranibizumab. If there is complete regression of polyps by indocyanine green angiography, but there is leakage on fluorescein angiography and other clinical or anatomical signs of disease activity, eyes should be retreated with ranibizumab. CONCLUSION Practical guidance on the clinical management of PCV is proposed based on expert evaluation of current evidence.
Collapse
|
37
|
Kawamura A, Yuzawa M, Mori R, Haruyama M, Tanaka K. Indocyanine green angiographic and optical coherence tomographic findings support classification of polypoidal choroidal vasculopathy into two types. Acta Ophthalmol 2013; 91:e474-81. [PMID: 23848133 DOI: 10.1111/aos.12110] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE We assessed the characteristic indocyanine green angiographic (ICGA) and spectral domain optical coherence tomographic (SD-OCT) findings of two types of polypoidal choroidal vasculopathy (PCV), distinguishable by different filling patterns on ICGA. METHODS Thirty-one eyes with PCV were classified into types 1 and 2 based on ICGA findings of either the presence or absence of both a feeder and a draining vessel. Characteristic ICGA findings were evaluated for each type of PCV. Spectral domain optical coherence tomographic images of the 31 eyes were also used to compare the two types of PCV. RESULTS Both a feeder and a draining vessel were observed in 13 eyes (type 1). Eighteen eyes had neither feeder nor draining vessels (type 2). In PCV type 1, a break in the highly reflective line thought to be Bruch's membrane was detected, corresponding to the feeder vessel in-growth site on SD-OCT. This line was straight. In PCV type 2, the highly reflective line exhibited irregular thickness and had highly reflective substances adhering to its lower portion. It curved downward and became increasingly obscure, ultimately disappearing at a point corresponding to the site at which network vessel filling began. The mean subfoveal choroidal thicknesses in eyes with PCV type 1 and PCV type 2 were 199 ± 65 and 288 ± 98 μm, respectively. CONCLUSIONS Our observations support the existence of two distinct types of PCV. The first type represents choroidal neovascularization, whilst the second type involves choroidal vasculature abnormalities.
Collapse
Affiliation(s)
- Akiyuki Kawamura
- Department of Ophthalmology, School of Medicine, Nihon University, Tokyo, Japan
| | | | | | | | | |
Collapse
|
38
|
Changes in fundus autofluorescence in polypoidal choroidal vasculopathy during 3 years of follow-up. Graefes Arch Clin Exp Ophthalmol 2013; 251:2331-7. [DOI: 10.1007/s00417-013-2336-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 03/12/2013] [Accepted: 03/19/2013] [Indexed: 10/26/2022] Open
|
39
|
de Amorim Garcia Filho CA, Yehoshua Z, Gregori G, Puliafito CA, Rosenfeld PJ. Optical Coherence Tomography. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00003-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
40
|
Pathogenesis of Serous Detachment of the Retina and Pigment Epithelium. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00030-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
41
|
Sia DIT, Ebneter A, Sinkar S, Gilhotra J. Polypoidal choroidal vasculopathy: naked polyp. Int Ophthalmol 2012. [PMID: 23183910 DOI: 10.1007/s10792-012-9681-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present an unusual case of polypoidal choroidal vasculopathy (PCV) lying above the retinal pigment epithelium (RPE) in a 60-year-old Caucasian female. PCV lesions are typically located beneath the RPE layer. However, they may rarely lie above the level of the RPE due to a discontinuity in the RPE and Bruch's membrane.
Collapse
Affiliation(s)
- David I T Sia
- Discipline of Ophthalmology & Visual Sciences, University of Adelaide, South Australian Institute of Ophthalmology, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia.
| | | | | | | |
Collapse
|
42
|
Keane PA, Patel PJ, Liakopoulos S, Heussen FM, Sadda SR, Tufail A. Evaluation of Age-related Macular Degeneration With Optical Coherence Tomography. Surv Ophthalmol 2012; 57:389-414. [PMID: 22898648 DOI: 10.1016/j.survophthal.2012.01.006] [Citation(s) in RCA: 164] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 01/20/2012] [Accepted: 01/20/2012] [Indexed: 12/28/2022]
|
43
|
Lee WK, Kim KS, Kim W, Lee SB, Jeon S. Responses to photodynamic therapy in patients with polypoidal choroidal vasculopathy consisting of polyps resembling grape clusters. Am J Ophthalmol 2012; 154:355-365.e1. [PMID: 22541658 DOI: 10.1016/j.ajo.2012.02.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 02/11/2012] [Accepted: 02/13/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To investigate the responses to photodynamic therapy (PDT) in patients with polypoidal choroidal vasculopathy (PCV) that show large aneurysmal dilation with internal angio-architecture consisting of diverse patterns of curvilinear vessels and polyps resembling grape clusters. DESIGN Retrospective, interventional case series. METHODS Twenty-two eyes of 22 patients were included. All patients initially received PDT monotreatment. The main outcome measures were the rates of complete polyp regression on indocyanine green angiography and initial favorable responses observed clinically. Also, the rates of recurrent exudative changes were evaluated at the 2-year follow-up. We focused on changes in the vascular features and their clinical association. RESULTS Complete regression of polypoidal lesions was observed in 21 eyes (95%) after a mean of 1.7 PDTs. However, favorable clinical responses were achieved in only 9 eyes (41%), and 6 of them had recurrent exudation. Main vessels, previously consisting of the polypoidal lesion frame, persisted. Additionally, aberrant vessels with a thin radiating or tortuous configuration were observed in the area where large aneurysmal dilation was present. Leakage from this vascular complex or an expanded vascular complex was observed in a total of 14 eyes (64%) during the 2-year follow-up, contributing to persistent (8 eyes) or recurrent (6 eyes) exudation. This seemed to represent secondary choroidal neovascularization (CNV). In another 4 eyes (18%), fibrous changes developed immediately after PDT. Polyps recurred in 8 eyes (38%). CONCLUSIONS This PCV pattern frequently evolved into typical CNV after PDT, resulting in persistent or recurrent exudation despite the disappearance of polypoidal structures.
Collapse
|
44
|
Fundus Autofluorescence in Polypoidal Choroidal Vasculopathy. Ophthalmology 2012; 119:1650-7. [DOI: 10.1016/j.ophtha.2012.02.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 01/13/2012] [Accepted: 02/09/2012] [Indexed: 11/20/2022] Open
|
45
|
Nagase S, Miura M, Makita S, Iwasaki T, Goto H, Yasuno Y. High-penetration optical coherence tomography with enhanced depth imaging of polypoidal choroidal vasculopathy. Ophthalmic Surg Lasers Imaging Retina 2012; 43 Online:e5-9. [PMID: 22320832 DOI: 10.3928/15428877-20120130-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 01/06/2012] [Indexed: 11/20/2022]
Abstract
A combination of high-penetration spectral-domain optical coherence tomography (central wavelength: 1,020 nm) and an enhanced depth imaging protocol (HP-EDI-OCT) was used to evaluate 5 eyes of 5 patients with polypoidal choroidal vasculopathy (PCV). In all eyes, HP-EDI-OCT provided high-contrast images of PCV lesions in the subretinal pigment epithelium (sub-RPE). In the space between the RPE line and Bruch's membrane, various PCV lesions, including vascular networks, polypoidal lesions, and sub-RPE hemorrhage, were clearly identified. The chorioscleral interface was clearly observed, and the entire structure of the choroid was readily identified. Thus, HP-EDI-OCT was useful for evaluating sub-RPE lesions of PCV.
Collapse
Affiliation(s)
- Satoko Nagase
- Department of Ophthalmology, Tokyo Medical University, Ibaraki Medical Center, Ami, Japan
| | | | | | | | | | | |
Collapse
|
46
|
Bevacizumab for serous changes originating from a persistent branching vascular network following photodynamic therapy for polypoidal choroidal vasculopathy. Jpn J Ophthalmol 2011; 55:370-377. [DOI: 10.1007/s10384-011-0045-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 03/16/2011] [Indexed: 10/18/2022]
|
47
|
Tsujikawa A, Ojima Y, Yamashiro K, Nakata I, Ooto S, Tamura H, Nakanishi H, Hayashi H, Otani A, Yoshimura N. Association of lesion size and visual prognosis to polypoidal choroidal vasculopathy. Am J Ophthalmol 2011; 151:961-972.e1. [PMID: 21457926 DOI: 10.1016/j.ajo.2011.01.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 12/22/2010] [Accepted: 01/03/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the progression of vascular lesions of polypoidal choroidal vasculopathy (PCV) as viewed with indocyanine green angiography and the visual prognosis of these eyes. DESIGN Retrospective case study. METHODS We reviewed retrospectively the medical records of 88 consecutive patients (88 eyes) with PCV who had been examined with indocyanine green angiography for more than 2 years. RESULTS Depending on the initial area of the vascular lesion, eyes were divided into smaller PCV (baseline area of lesion being < 1 disc area [DA], n = 22) and larger PCV (baseline area of lesion being ≥ 1 DA, n = 66). In larger PCV, the mean area of the lesion progressed significantly from 6.49 ± 8.96 mm(2) to 16.27 ± 14.19 mm(2) (P < .0001) with marked deterioration of visual acuity (P < .0001) during follow-up. In contrast, smaller PCV often showed minimal progression of the lesion, only limited exudative change, and the eyes maintained their initially good vision to the final visit. Smaller PCV lesions rarely progressed to extensive PCV lesions. Severe vision-threatening complications (ie, suprachoroidal hemorrhage, vitreous hemorrhage, and tears of the retinal pigment epithelium) were seen only in eyes with larger PCV, and in studying single nucleotide polymorphisms A69S of ARMS2 genes, there was a significant difference in T allele frequency between individuals with smaller PCV and those with larger PCV (20.2% vs 79.8%; P = .0235). CONCLUSIONS PCV with small vascular lesions shows minimal progression and no vision-threatening complications, and these eyes often maintain good visual acuity for a long time.
Collapse
|
48
|
RETINAL MICROSTRUCTURAL ABNORMALITIES IN CENTRAL SEROUS CHORIORETINOPATHY AND POLYPOIDAL CHOROIDAL VASCULOPATHY. Retina 2011; 31:527-34. [DOI: 10.1097/iae.0b013e3181eef2db] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
49
|
|
50
|
Thickness of photoreceptor layers in polypoidal choroidal vasculopathy and central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2010; 248:1077-86. [DOI: 10.1007/s00417-010-1338-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 01/29/2010] [Accepted: 02/14/2010] [Indexed: 10/19/2022] Open
|