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Zhao J, Chandrasekaran PR, Cheong KX, Wong M, Teo K. New Concepts for the Diagnosis of Polypoidal Choroidal Vasculopathy. Diagnostics (Basel) 2023; 13:diagnostics13101680. [PMID: 37238165 DOI: 10.3390/diagnostics13101680] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/06/2023] [Accepted: 05/07/2023] [Indexed: 05/28/2023] Open
Abstract
Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular age-related macular degeneration (nAMD) that is characterized by a branching neovascular network and polypoidal lesions. It is important to differentiate PCV from typical nAMD as there are differences in treatment response between subtypes. Indocyanine green angiography (ICGA) is the gold standard for diagnosing PCV; however, ICGA is an invasive detection method and impractical for extensive use for regular long-term monitoring. In addition, access to ICGA may be limited in some settings. The purpose of this review is to summarize the utilization of multimodal imaging modalities (color fundus photography, optical coherence tomography (OCT), OCT angiography (OCTA), and fundus autofluorescence (FAF)) in differentiating PCV from typical nAMD and predicting disease activity and prognosis. In particular, OCT shows tremendous potential in diagnosing PCV. Characteristics such as subretinal pigment epithelium (RPE) ring-like lesion, en face OCT-complex RPE elevation, and sharp-peaked pigment epithelial detachment provide high sensitivity and specificity for differentiating PCV from nAMD. With the use of more practical, non-ICGA imaging modalities, the diagnosis of PCV can be more easily made and treatment tailored as necessary for optimal outcomes.
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Affiliation(s)
- Jinzhi Zhao
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- Tianjin Medical University Eye Hospital, Tianjin 300392, China
| | - Priya R Chandrasekaran
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Kai Xiong Cheong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Mark Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Kelvin Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore 169857, Singapore
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Cheung CMG, Lai TYY, Teo K, Ruamviboonsuk P, Chen SJ, Kim JE, Gomi F, Koh AH, Kokame G, Jordan-Yu JM, Corvi F, Invernizzi A, Ogura Y, Tan C, Mitchell P, Gupta V, Chhablani J, Chakravarthy U, Sadda SR, Wong TY, Staurenghi G, Lee WK. Polypoidal Choroidal Vasculopathy: Consensus Nomenclature and Non-Indocyanine Green Angiograph Diagnostic Criteria from the Asia-Pacific Ocular Imaging Society PCV Workgroup. Ophthalmology 2020; 128:443-452. [PMID: 32795496 DOI: 10.1016/j.ophtha.2020.08.006] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To develop consensus terminology in the setting of polypoidal choroidal vasculopathy (PCV) and to develop and validate a set of diagnostic criteria not requiring indocyanine green angiography (ICGA) for differentiating PCV from typical neovascular age-related macular degeneration (nAMD) based on a combination of OCT and color fundus photography findings. DESIGN Evaluation of diagnostic test results. PARTICIPANTS Panel of retina specialists. METHODS As part of the Asia-Pacific Ocular Imaging Society, an international group of experts surveyed and discussed the published literature regarding the current nomenclature and lesion components for PCV, and proposed an updated consensus nomenclature that reflects our latest understanding based on imaging and histologic reports. The workgroup evaluated a set of diagnostic features based on OCT images and color fundus photographs for PCV that may distinguish it from typical nAMD and assessed the performance of individual and combinations of these non-ICGA features, aiming to propose a new set of diagnostic criteria that does not require the use of ICGA. The final recommendation was validated in 80 eyes from 2 additional cohorts. MAIN OUTCOME MEASURES Consensus nomenclature system for PCV lesion components and non-ICGA-based criteria to differentiate PCV from typical nAMD. RESULTS The workgroup recommended the terms polypoidal lesion and branching neovascular network for the 2 key lesion components in PCV. For the diagnosis of PCV, the combination of 3 OCT-based major criteria (sub-retinal pigment epithelium [RPE] ring-like lesion, en face OCT complex RPE elevation, and sharp-peaked PED) achieved an area under the receiver operating characteristic curve of 0.90. Validation of this new scheme in a separate subset 80 eyes achieved an accuracy of 82%. CONCLUSIONS We propose updated terminology for PCV lesion components that better reflects the nature of these lesions and is based on international consensus. A set of practical diagnostic criteria applied easily to spectral-domain OCT results can be used for diagnosing PCV with high accuracy in clinical settings in which ICGA is not performed routinely.
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Affiliation(s)
- Chui M Gemmy Cheung
- Medical Retina Department, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore.
| | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong, China
| | - Kelvin Teo
- Medical Retina Department, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
| | | | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Judy E Kim
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Fumi Gomi
- Department of Ophthalmology, Hyogo College of Medicine, Hyogo, Japan
| | - Adrian H Koh
- Medical Retina Department, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore; Eye and Retina Surgeons, Camden Medical Centre, Singapore, Republic of Singapore
| | - Gregg Kokame
- Division of Ophthalmology, Department of Surgery, University of Hawaii School of Medicine, Honolulu, Hawaii
| | - Janice Marie Jordan-Yu
- Medical Retina Department, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Federico Corvi
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Milan, Italy; Save Sight Institute, Faculty of Health and Medicine, The University of Sydney, Sydney, Australia
| | - Yuichiro Ogura
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Colin Tan
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Republic of Singapore
| | - Paul Mitchell
- Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Vishali Gupta
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Jay Chhablani
- University of Pittsburgh Eye Center, Pittsburgh, Pennsylvania
| | - Usha Chakravarthy
- Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore; School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, United Kingdom
| | - Srinivas R Sadda
- Doheny Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Tien Y Wong
- Medical Retina Department, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Milan, Italy
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Polypoidal Choroidal Vasculopathy in Congolese Patients. J Ophthalmol 2020; 2020:4103871. [PMID: 32051763 PMCID: PMC6995324 DOI: 10.1155/2020/4103871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/21/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose Polypoidal choroidal vasculopathy (PCV) is a visually debilitating disease that mostly affects people of African and Asian heritage. Indocyanine green angiography (ICGA) is the recommended exploratory method for definitive diagnosis. The disease has been extensively described in Asians and Caucasians, but not in Africans. This study was conducted to document the clinical presentation and optical coherence tomography features of polypoidal choroidal vasculopathy (PCV) in Congolese patients. Methods A prospective case series of patients with PCV was performed between January 2017 and June 2019. Routine ocular examination was performed including best corrected visual acuity measurement, slit-lamp examination, dilated direct fundoscopy, and spectral domain optical coherence tomography (OCT). The diagnosis was based on a combination of clinical and OCT signs. Results Fourteen patients were diagnosed with PCV during this period. The average age was 64.7 ± 6.9 years. There were 8 females. Ten (71.4%) patients had systemic hypertension. Most patients (n = 9, 64.3%) had bilateral involvement. Blurred vision was the most common complaint (71.4%). The main clinical presentation was subretinal exudates, seen in 19 (82.6%) eyes of 11 (78.6%) patients and subretinal hemorrhage in 10 (43.5%) eyes. Macular localization was found in 16 eyes (69.5%) of 12 (85.7%) patients. Drusen were observed in 35.7% of the patients. On OCT imaging, thumb-like pigment epithelial detachment and subretinal exudation were the most frequent features, observed in 92.9% and 71.4% of the patients, respectively. Conclusions PCV in Congolese patients showed features that are more similar to those observed in Caucasians. In this setting where indocyanine green angiography is not available, OCT facilitates the diagnosis of PCV.
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SENSITIVITY AND SPECIFICITY OF DETECTING POLYPOIDAL CHOROIDAL VASCULOPATHY WITH EN FACE OPTICAL COHERENCE TOMOGRAPHY AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina 2019; 39:1343-1352. [DOI: 10.1097/iae.0000000000002139] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Purpose of review The aim of this review is to summarize developments in the treatment of active polypoidal choroidal vasculopathy (PCV). PCV is associated with a poor visual prognosis as a consequence the condition's hallmark polypoidal dilatation and a branching network resulting in recurrent hemorrhages and serous leakage. Recent findings Recent research has provided new insights into the pathogenesis of PCV. While still considered a subtype of age-related macular degeneration, suggestions that PCV belongs to a spectrum of conditions that present with a pachychoroid are increasingly well accepted. Treatment remains challenging. Combination therapy (photodynamic therapy (PDT) and intravitreal anti-vascular endothelial growth factor (VEGF)) is associated with higher polyp closure rate, but polyp closure rate has not been correlated with superior visual outcomes. Current data points to non-inferiority of anti-VEGF alone versus combined with PDT when final vision acuity is the study outcome. Summary PCV remains a clinical challenge. Classification and treatment of the condition continues to evolve. Combination therapy may not be superior to anti-VEGF treatment alone in terms of visual acuity outcome, however data on long-term recurrence should be compared in formulating preferred treatment plans.
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Takahashi K, Ohji M, Terasaki H, Honda S, Margaron P, Guerin T, Yuzawa M. Efficacy and safety of ranibizumab monotherapy versus ranibizumab in combination with verteporfin photodynamic therapy in patients with polypoidal choroidal vasculopathy: 12-month outcomes in the Japanese cohort of EVEREST II study. Clin Ophthalmol 2018; 12:1789-1799. [PMID: 30271112 PMCID: PMC6145359 DOI: 10.2147/opth.s171015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare the efficacy and safety of ranibizumab 0.5 mg with or without verteporfin photodynamic therapy in Japanese patients with polypoidal choroidal vasculopathy over 12 months. Study design EVEREST II was a 24-month, Phase IV, multicenter, randomized, double-masked study in Asian patients with symptomatic macular polypoidal choroidal vasculopathy. Methods Of the 322 enrolled patients, 84 patients, including 46 patients who received ranibizumab + verteporfin photodynamic therapy (combination therapy arm) and 38 patients who received ranibizumab/sham PDT (monotherapy arm), were Japanese who were evaluated in this subanalysis. Mean change in best-corrected visual acuity (BCVA) and complete polyp regression at Month 12, ranibizumab treatment exposure, and safety over 12 months were assessed. Results Baseline demographics were well balanced between the arms. At Month 12, mean change in BCVA letter score was +8.5 with combination therapy versus +6.4 with monotherapy. Complete polyp regression was higher with combination therapy than with monotherapy at Month 12 (70.5% vs 27.3%). Over 12 months, patients in the combination arm received a median of 4.0 ranibizumab injections vs 7.0 in the monotherapy arm. Serious adverse events were generally low in both arms, and retinal hemorrhage, an adverse event, was reported in one patient (2.2%). Conclusion The results from the Japanese cohort were in agreement with the EVEREST II study. Combination therapy was effective in improving BCVA and achieving a higher rate of complete polyp regression with a lower number of ranibizumab injections than monotherapy. No new safety signals were reported, and safety events were comparable between both arms over 12 months.
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Affiliation(s)
- Kanji Takahashi
- Department of Ophthalmology, Kansai Medical University, Osaka, Japan,
| | - Masahito Ohji
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
| | - Hiroko Terasaki
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shigeru Honda
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Tadhg Guerin
- Department of Ophthalmology, Novartis Ireland Limited, Dublin, Ireland
| | - Mitsuko Yuzawa
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, Tokyo, Japan
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de Carlo T, Kokame G, Shantha J, Lai J, Wee R. Spectral-Domain Optical Coherence Tomography Angiography for the Diagnosis and Evaluation of Polypoidal Choroidal Vasculopathy. Ophthalmologica 2017; 239:103-109. [DOI: 10.1159/000481540] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 09/13/2017] [Indexed: 11/19/2022]
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Kokame GT, Shantha JG, Hirai K, Ayabe J. En Face Spectral-Domain Optical Coherence Tomography for the Diagnosis and Evaluation of Polypoidal Choroidal Vasculopathy. Ophthalmic Surg Lasers Imaging Retina 2017; 47:737-44. [PMID: 27548451 DOI: 10.3928/23258160-20160808-07] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/07/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the diagnostic capability of en face spectral-domain optical coherence tomography (SD-OCT) in patients with polypoidal choroidal vasculopathy (PCV) diagnosed by indocyanine green angiography (ICGA). PATIENTS AND METHODS A retrospective, consecutive case series of 100 eyes diagnosed with PCV by ICGA were imaged with en face SD-OCT. Evaluation of the PCV complex on en face SD-OCT was performed on the ability to diagnose PCV by the characteristic configuration of the PCV complex and the extent and size of the PCV lesion. RESULTS The PCV complex was better visualized on ICGA in 45 eyes, on en face SD-OCT in 44 eyes, and equally well in 11 eyes. The extent of the PCV complex was larger on en face SD-OCT in 65 eyes, larger on ICGA in 23 eyes, and equal in size in 12 eyes. CONCLUSION En face SD-OCT images the characteristic findings of PCV and provides a noninvasive way to diagnose and treat PCV when ICGA is not available. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:737-744.].
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Simonett JM, Chan EW, Chou J, Skondra D, Colon D, Chee CK, Lingam G, Fawzi AA. Quantitative Analysis of En Face Spectral-Domain Optical Coherence Tomography Imaging in Polypoidal Choroidal Vasculopathy. Ophthalmic Surg Lasers Imaging Retina 2017; 48:126-133. [PMID: 28195615 DOI: 10.3928/23258160-20170130-06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/12/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Spectral-domain optical coherence tomography (SD-OCT) imaging can be used to visualize polypoidal choroidal vasculopathy (PCV) lesions in the en face plane. Here, the authors describe a novel lesion quantification technique and compare PCV lesion area measurements and morphology before and after anti-vascular endothelial growth factor (VEGF) treatment. PATIENTS AND METHODS Volumetric SD-OCT scans in eyes with PCV before and after induction anti-VEGF therapy were retrospectively analyzed. En face SD-OCT images were generated and a pixel intensity thresholding process was used to quantify total lesion area. RESULTS Thirteen eyes with PCV were analyzed. En face SD-OCT PCV lesion area quantification showed good intergrader reliability (intraclass correlation coefficient = 0.944). Total PCV lesion area was significantly reduced after anti-VEGF therapy (2.22 mm2 vs. 2.73 mm2; P = .02). The overall geographic pattern of the branching vascular network was typically preserved. CONCLUSION PCV lesion area analysis using en face SD-OCT is a reproducible tool that can quantify treatment related changes. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:126-133.].
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Alasil T, Munoz N, Keane PA, Tufail A, Coady PA, Novais E, de Carlo TE, Baumal CR, Waheed NK, Duker JS, Adelman RA. Characteristics and racial variations of polypoidal choroidal vasculopathy in tertiary centers in the United States and United Kingdom. Int J Retina Vitreous 2017; 3:9. [PMID: 28428893 PMCID: PMC5392942 DOI: 10.1186/s40942-017-0060-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/17/2017] [Indexed: 01/01/2023] Open
Abstract
Purpose To evaluate the characteristics and racial variations amongst patients with polypoidal choroidal vasculopathy (PCV) in the United States and the United Kingdom. Methods Fundus photos and indocyanine green angiography images were evaluated in a multicenter retrospective study to establish the diagnosis of PCV. Visual acuity (VA) was recorded in ETDRS letter count. Results Eighty eyes of 71 PCV patients (average age of 69.4 ± 10.4 years) were included in the analysis. Of the total 71 subjects, 46 (65%) were women, 33 (46.5%) were Blacks, 16 (22.5%) were Whites, 19 (26.8%) were Asians and 3 (4.2%) belonged to other races. The Black subgroup had vision gain of 3.5 letters. The White and Asian subgroups had vision loss of 13.1 and 3.5 letters, respectively. There was female predominance in Blacks (67%), Whites (69%), and Asians (58%). PCV was found to be a bilateral disease in 14 patients (20%). There was significant decrease of 7 letters with every decade increase in age (p = 0.005). Final VA was worse in males when compared to females (p = 0.042), and worse in Whites when compared to Blacks (p = 0.005). For every 10 letters worse in initial VA upon diagnosis with PCV, the final VA was worse by 6 letters (p < 0.001). The location of the polypoidal lesion within the macula was associated with significant decrease of 14 letters in BCVA (p = 0.02). The length of follow up was significantly associated with worse visual outcome (p = 0.012). Final VA had no significant correlation with the lens status, or the different treatment modalities. Conclusions Based on our cohort from tertiary centers in the United States and United Kingdom, PCV is a bilateral disease in one-fifth of patients. It features a variable female predominance based on ethnicity. Increased age, worse vision upon initial presentation, longer follow up and macular location of the polyp were associated with worse visual outcome. Electronic supplementary material The online version of this article (doi:10.1186/s40942-017-0060-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tarek Alasil
- Department of Ophthalmology and Visual Sciences, School of Medicine, Yale University, New Haven, CT USA
| | - Nelida Munoz
- Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - Pearse A Keane
- Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - Adnan Tufail
- Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - Patrick A Coady
- Department of Ophthalmology and Visual Sciences, School of Medicine, Yale University, New Haven, CT USA
| | - Eduardo Novais
- New England Eye Center, Tufts Medical Center, Boston, MA USA.,School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | | | | | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, MA USA
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, MA USA
| | - Ron A Adelman
- Department of Ophthalmology and Visual Sciences, School of Medicine, Yale University, New Haven, CT USA
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Lau T, Wong IY, Iu L, Chhablani J, Yong T, Hideki K, Lee J, Wong R. En-face optical coherence tomography in the diagnosis and management of age-related macular degeneration and polypoidal choroidal vasculopathy. Indian J Ophthalmol 2016; 63:378-83. [PMID: 26139796 PMCID: PMC4501131 DOI: 10.4103/0301-4738.159860] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Optical coherence tomography (OCT) is a noninvasive imaging modality providing high-resolution images of the central retina that has completely transformed the field of ophthalmology. While traditional OCT has produced longitudinal cross-sectional images, advancements in data processing have led to the development of en-face OCT, which produces transverse images of retinal and choroidal layers at any specified depth. This offers additional benefit on top of longitudinal cross-sections because it provides an extensive overview of pathological structures in a single image. The aim of this review was to discuss the utility of en-face OCT in the diagnosis and management of age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). En-face imaging of the inner segment/outer segment junction of retinal photoreceptors has been shown to be a useful indicator of visual acuity and a predictor of the extent of progression of geographic atrophy. En-face OCT has also enabled high-resolution analysis and quantification of pathological structures such as reticular pseudodrusen (RPD) and choroidal neovascularization, which have the potential to become useful markers for disease monitoring. En-face Doppler OCT enables subtle changes in the choroidal vasculature to be detected in eyes with RPD and AMD, which has significantly advanced our understanding of their pathogenesis. En-face Doppler OCT has also been shown to be useful for detecting the polypoid lesions and branching vascular networks diagnostic of PCV. It may therefore serve as a noninvasive alternative to fluorescein and indocyanine green angiography for the diagnosis of PCV and other forms of the exudative macular disease.
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Affiliation(s)
| | - Ian Y Wong
- The Department of Ophthalmology, The University of Hong Kong,, Hong Kong, China
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Sodi A, Mucciolo DP, Cipollini F, Murro V, Caporossi O, Virgili G, Rizzo S. En face OCT in Stargardt disease. Graefes Arch Clin Exp Ophthalmol 2016; 254:1669-79. [PMID: 26743751 DOI: 10.1007/s00417-015-3254-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/15/2015] [Accepted: 12/21/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the structural features of the macular region by enface OCT imaging in patients with clinical diagnosis of Stargardt disease, confirmed by the detection of ABCA4 mutations. METHODS Thirty-two STGD patients were included in the study for a total of 64 eyes. All patients received a comprehensive ophthalmological examination, color fundus photography, fundus auto-fluorescence imaging and OCT. Five OCT scans were considered: ILM and RPE scans (both automatically obtained from the instrument), above-RPE slab, photoreceptor slab and sub-RPE slab (these last three manually obtained). RESULTS ILM scans showed evident radial folds on the retinal surface in 8/64 eyes (12.5 %). In 6 of the 7 patients, these vitreo-retinal interface abnormalities were unilateral. The photoreceptor slab showed some macular alterations ranging from dis-homogeneous, hypo-reflective abnormalities (7/64 eyes, 11 %) to a homogeneous, well-defined, roundish, hypo-reflective area (17/64 eyes, 27 %) in all the eyes. The sub-RPE slab showed a centrally evident, hyper-reflective abnormality in 58/64 eyes (90.6 %). Superimposing the sub-RPE slab over the images corresponding to the photoreceptor slab, the area of the photoreceptor atrophy sharply exceeded that of the RPE atrophy (44/46 eyes, 96 %). CONCLUSION Enface OCT proved to be a clinically useful tool for the management of STGD patients, illustrating in vivo the structural abnormalities of the different retinal layers.
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Affiliation(s)
- Andrea Sodi
- Careggi Teaching Hospital , Eye Clinic, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Dario Pasquale Mucciolo
- Careggi Teaching Hospital , Eye Clinic, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Francesca Cipollini
- Careggi Teaching Hospital , Eye Clinic, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Vittoria Murro
- Careggi Teaching Hospital , Eye Clinic, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Orsola Caporossi
- Careggi Teaching Hospital , Eye Clinic, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Gianni Virgili
- Careggi Teaching Hospital , Eye Clinic, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Stanislao Rizzo
- Careggi Teaching Hospital , Eye Clinic, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
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Asensio-Sánchez VM. SD-OCT findings in polypoidal choroidal vasculopathy. ACTA ACUST UNITED AC 2015; 91:23-6. [PMID: 26621225 DOI: 10.1016/j.oftal.2015.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 04/25/2015] [Accepted: 07/01/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine patients with polypoidal choroidal vasculopathy (PCV), using spectral-domain optical coherence tomography (SD-OCT) to characterise and locate the PCV lesions. PATIENTS AND METHODS A series of 15 eyes of 10 patients diagnosed with PCV were examined. All eyes were imaged with macular SD-OCT. RESULTS SD-OCT cross-sectional scan findings included atypical and typical pigment epithelial detachments (PEDs). Polyps and neovascularisation were located above Bruch membrane. All 15 eyes (100%) showed sub-retinal fluid (SRF) in association with PEDs. CONCLUSION These SD-OCT findings located the vascular lesions of PCV in the sub-retinal pigment epithelium (RPE) space, and strongly suggest that PCV is a variant of type 1 neovascularization.
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Affiliation(s)
- V M Asensio-Sánchez
- Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, España.
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Novais EA, Ferrara D, Waheed NK. Optical coherence tomography in polypoidal choroidal vasculopathy disease. Clin Exp Ophthalmol 2015; 43:779-81. [DOI: 10.1111/ceo.12676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Eduardo A Novais
- New England Eye Center, Tufts Medical Center; Boston Massachusetts USA
- School of Medicine; Federal University of São Paulo; São Paulo Brazil
| | - Daniela Ferrara
- New England Eye Center, Tufts Medical Center; Boston Massachusetts USA
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center; Boston Massachusetts USA
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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.
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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
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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.
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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
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17
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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.
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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.
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Alshahrani ST, Al Shamsi HN, Kahtani ES, Ghazi NG. Spectral-domain optical coherence tomography findings in polypoidal choroidal vasculopathy suggest a type 1 neovascular growth pattern. Clin Ophthalmol 2014; 8:1689-95. [PMID: 25214762 PMCID: PMC4159396 DOI: 10.2147/opth.s68471] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To report spectral-domain optical coherence tomography (SD-OCT) findings in polypoidal choroidal vasculopathy (PCV). PATIENTS AND METHODS Seventeen eyes of 15 consecutive patients diagnosed with PCV based on typical clinical and angiographic findings were imaged with macular SD-OCT including line scans passing through the polyps. RESULTS SD-OCT findings included typical and atypical retinal pigment epithelial (RPE) detachments and subretinal and intraretinal fluid in all eyes. In the areas corresponding to the polypoidal lesions, well-delineated round-oval, sub-RPE cavities were present and were adherent to the posterior surface of the detached RPE above Bruch membrane. No retinal or choroidal connections to the cavities were noted. CONCLUSION These SD-OCT findings document that the vascular lesions in PCV are not located in the inner choroid, but in the sub-RPE space, suggesting that PCV is a variant of type 1 choroidal neovascularization rather than a distinct clinical entity as initially thought.
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Affiliation(s)
- Saeed T Alshahrani
- King Fahad Specialist Hospital, Dammam, Saudi Arabia
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | - Eman S Kahtani
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Nicola G Ghazi
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- University of Virginia, Department of Ophthalmology, Charlottesville, VA, USA
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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]
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21
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Polypoidal choroidal vasculopathy--an important diagnosis to make with therapeutic implications. Retina 2012; 32:1446-8. [PMID: 22922845 DOI: 10.1097/iae.0b013e3182695bf8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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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]
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23
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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
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