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Hao X, He G, Li M, Pu J, Zhuang X, Su Y, Zhang X, Wen F. Widefield Indocyanine Green Angiography Evaluating Choroidal Vein Drainage Pattern and Choroidal Vein Alterations in Acute and Chronic Central Serous Chorioretinopathy. Photodiagnosis Photodyn Ther 2024:104358. [PMID: 39389526 DOI: 10.1016/j.pdpdt.2024.104358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 09/18/2024] [Accepted: 10/04/2024] [Indexed: 10/12/2024]
Abstract
PURPOSE To access the distribution of choroidal vein drainage pattern and the choroidal vein alterations in choroidal vascular hyperpermeability (CVH) areas in eyes with acute and chronic central serous chorioretinopathy (CSC) using widefield indocyanine green angiography (WF-ICGA). METHODS In this retrospective observational study, medical records and multimodal imaging of 127 patients (165 eyes) with CSC were reviewed. The number and location of dominant vortex veins and CVH areas on WF-ICGA images were evaluated. Choroidal vein alterations, including fusiform, bulbosity, sausaging, choroidal vein confluence and intervortex venous anastomosis, were identified in CVH areas. The differences of choroidal features were compared between acute and chronic groups. RESULTS Sixty-three acute CSC eyes and 102 chronic CSC eyes were evaluated. In this study, 125 eyes (75.76%) exhibited an asymmetric pattern of choroidal vein drainage routes. Chronic CSC group had more CVH areas compared with acute CSC eyes in general (P < 0.001). Compared with chronic CSC eyes, CVH areas in acute CSC eyes were more likely to occur in the dominant vortex vein system (P = 0.006). Regarding the choroidal vein alterations, all kinds of anatomical changes were significantly more pronounced in chronic CSC eyes compared with acute group (P < 0.001 for all), with sausaging and intervortex venous anastomosis more commonly observed in chronic group (P < 0.001 and P = 0.002, respectively). The best corrected visual acuity (BCVA) of chronic symmetric CSC was significantly better than that of chronic asymmetric CSC cases (P = 0.006), with the BCVA showing a correlation with the frequency of sausaging dilations (P = 0.032). An increased number of sausaging dilation was associated with poorer visual acuity in chronic asymmetric CSC. CONCLUSIONS Choroidal vascular remodeling occurs throughout the entire course of the CSC, with the formation of intervortex venous anastomosis creating a new drainage path that helps ameliorate choroidal vein congestion over time.
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Affiliation(s)
- Xinlei Hao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
| | - Guiqin He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
| | - Miaoling Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
| | - Jiaxin Pu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
| | - Xuenan Zhuang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
| | - Yongyue Su
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
| | - Xiongze Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
| | - Feng Wen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China.
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Noh H, Nam SW, Yoon JM, Ham DI. Choroidal venous overload in Vogt‒Koyanagi‒Harada disease. Eye (Lond) 2024; 38:2960-2967. [PMID: 38951674 PMCID: PMC11461802 DOI: 10.1038/s41433-024-03198-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 04/11/2024] [Accepted: 06/20/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND/OBJECTIVES This study aimed to investigate the change of choroidal venous overload in Vogt‒Koyanagi‒Harada (VKH) disease. Clinical records of 52 patients with VKH disease (52 eyes) and 24 control subjects (24 eyes) who underwent multimodal imaging, including fluorescein angiography (FA) and indocyanine green angiography (ICGA), were retrospectively reviewed. SUBJECTS/METHODS Imaging data were assessed for signs associated with choroidal venous overload, e.g., choroidal perfusion delay, choroidal vascular hyperpermeability, dilated choroidal veins, and intervortex venous anastomosis (IVA). Dual FA and ICGA scoring for active posterior segment inflammation was performed. Clinical and imaging features associated with choroidal venous overload were compared between early- and late-stage VKH disease. RESULTS Choroidal perfusion delay, choroidal vascular hyperpermeability, dilated choroidal veins, and IVA were more prevalent in eyes with VKH disease (69.2%, 67.3%, 61.5%, and 65.4%, respectively) than in control eyes (25.0%, 20.8%, 25.0%, and 37.5%, respectively) (p < 0.05). All eyes with IVA in the early-stage of VKH disease had got other 3 signs. All choroidal venous overload signs were more prevalent in patients with early-stage (20 eyes) than in those with late-stage VKH disease (32 eyes) (p < 0.05). The number of choroidal venous overload signs were inversely related to disease duration (p < 0.001) and proportionally related to the total ICGA score (p < 0.001). IVA was significantly associated with the total ICGA score in logistic regression (p = 0.014). CONCLUSIONS Choroidal venous overload occurs early in VKH disease. Angiographic signs of choroidal venous overload may be useful markers to assess the status of VKH disease.
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Affiliation(s)
- Hoon Noh
- Department of Ophthalmology, HanGil Eye Hospital, Incheon, Republic of Korea
| | - Seung Wan Nam
- Department of Ophthalmology, HanGil Eye Hospital, Incheon, Republic of Korea
- Department of Ophthalmology, Catholic Kwandong University College of Medicine, Gangneung, Republic of Korea
| | - Je Moon Yoon
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Don-Il Ham
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Matsumoto H, Kishi S, Hoshino J, Nakamura K, Akiyama H. Inversion of Asymmetric Vortex Vein Dilatation in Pachychoroid Spectrum Diseases. OPHTHALMOLOGY SCIENCE 2024; 4:100515. [PMID: 38827488 PMCID: PMC11143899 DOI: 10.1016/j.xops.2024.100515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/23/2024] [Accepted: 03/08/2024] [Indexed: 06/04/2024]
Abstract
Purpose Intervortex venous anastomosis is widely recognized as compensating for vortex vein congestion in pachychoroid spectrum diseases. However, determining the blood flow direction within the compensated drainage route is often challenging. Herein, we investigated the morphological patterns of vortex veins in eyes showing retrograde pulsatile vortex venous flow. Design Retrospective observational case series. Subjects Six hundred eighty-nine consecutive eyes with treatment-naive central serous chorioretinopathy, pachychoroid neovasculopathy, or polypoidal choroidal vasculopathy. Methods We reviewed the clinical records of patients with these pachychoroid spectrum diseases. Multimodal images including indocyanine green angiography (ICGA) and en face OCT were analyzed. Main Outcome Measures Intervortex venous anastomosis between superotemporal and inferotemporal vortex veins and the dominant site of dilated temporal vortex veins were determined in the eyes with retrograde pulsatile vortex venous flow in the temporal vortex veins. Results Twenty-two eyes with retrograde pulsatile vortex venous flow in the temporal vortex veins were identified utilizing early phase ICGA videos. In 9 eyes, retrograde pulsatile flow was detected in the superotemporal vortex veins, which were connected to the inferotemporal vortex veins via intervortex venous anastomoses. Among these cases, contralateral inferotemporal vortex vein dilatation was dominant in 7 eyes (77.8%), while superotemporal and inferotemporal vortex veins were symmetrically dilated in the other 2 eyes (22.2%). On the other hand, in 13 eyes, the retrograde pulsatile flow was detected in the inferotemporal vortex veins, which were linked to the superotemporal vortex veins via intervortex venous anastomoses. In these eyes, contralateral superotemporal vortex vein dilatation was dominant in 10 eyes (76.9%). Superotemporal and inferotemporal vortex veins were symmetrically dilated in 2 eyes (15.4%), while mainly inferotemporal vortex veins were dilated in 1 eye (7.7%). Conclusions In pachychoroid spectrum diseases, there are cases wherein congested venous blood might drain into the contralateral vortex veins via intervortex anastomoses. Overloaded contralateral vortex veins may, as a consequence, become more dilated than the primary congested vortex veins. Inversion of asymmetric vortex vein dilatation might thereby develop in pachychoroid spectrum diseases. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Hidetaka Matsumoto
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Shoji Kishi
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Junki Hoshino
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kosuke Nakamura
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hideo Akiyama
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Japan
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Nishi O, Nishi Y, Tatsumichi M, Yasukawa T. Pathogenesis of Pachyvein Formation in Central Serous Chorioretinopathy: A Hydrodynamic Analysis. J Clin Med 2024; 13:4777. [PMID: 39200919 PMCID: PMC11355752 DOI: 10.3390/jcm13164777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/02/2024] [Accepted: 08/08/2024] [Indexed: 09/02/2024] Open
Abstract
Objectives: To attain an understanding of pachyvein formation seen with central serous chorioretinopathy (CSC) by measuring the choroidal blood flow (CBF) velocity and to apply the findings to existing hydrodynamic theorems. Methods: Nineteen subjects with monocular CSC (mean age 51.8 ± 12.7 years) were included. Laser speckle flowgraphy measured the mean blur rate (MBR) in the foveal and perifoveal regions, and the findings were applied to the Equation of Continuity (Q = AV) and Bernoulli's theorem (1/2V2 + P/ρ = constant). Results: The mean foveal/perifoveal MBRs in the CSC eyes were 6.4 ± 3.2/9.6 ± 3.2 (p < 0.001). The mean MBRs in the non-CSC eyes were 8.3 ± 3.2/7.9 ± 2.4 (p = 0.37). The significant foveal CBF velocity decrease in CSC eyes occurs because of exudation from the hyperpermeable choriocapillaris. The subsequent decrease in blood volume due to the exudation elicits a decrease in the blood flow velocity in the inferior venules in accordance with the Equation of Continuity. The decrease in the blood flow velocity may result in an elevated blood flow pressure in the inferior venules and veins at the exudation site, in accordance with Bernoulli's theorem. Conclusion: A significant decrease in the foveal MBR may result from exudation from the hyperpermeable macular choriocapillaris. This decreased velocity may elicit a blood pressure elevation that can expand the inferior venules and veins at the exudation site, so-called pachyvein and pachychoroid formation. The application of hydrodynamic theorems to the measurement of ocular blood flow can provide new insights into the understanding of the pathogenesis of chorioretinal disease.
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Affiliation(s)
- Okihiro Nishi
- Jinshikai Medical Foundation, Nishi Eye Hospital, 4-14-26 Nakamichi, Higashinari-ku, Osaka 537-0025, Japan; (Y.N.); (M.T.)
| | - Yutaro Nishi
- Jinshikai Medical Foundation, Nishi Eye Hospital, 4-14-26 Nakamichi, Higashinari-ku, Osaka 537-0025, Japan; (Y.N.); (M.T.)
| | - Miki Tatsumichi
- Jinshikai Medical Foundation, Nishi Eye Hospital, 4-14-26 Nakamichi, Higashinari-ku, Osaka 537-0025, Japan; (Y.N.); (M.T.)
| | - Tsutomu Yasukawa
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya 464-8601, Japan;
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Feenstra HMA, van Dijk EHC, Cheung CMG, Ohno-Matsui K, Lai TYY, Koizumi H, Larsen M, Querques G, Downes SM, Yzer S, Breazzano MP, Subhi Y, Tadayoni R, Priglinger SG, Pauleikhoff LJB, Lange CAK, Loewenstein A, Diederen RMH, Schlingemann RO, Hoyng CB, Chhablani JK, Holz FG, Sivaprasad S, Lotery AJ, Yannuzzi LA, Freund KB, Boon CJF. Central serous chorioretinopathy: An evidence-based treatment guideline. Prog Retin Eye Res 2024; 101:101236. [PMID: 38301969 DOI: 10.1016/j.preteyeres.2024.101236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024]
Abstract
Central serous chorioretinopathy (CSC) is a relatively common disease that causes vision loss due to macular subretinal fluid leakage and it is often associated with reduced vision-related quality of life. In CSC, the leakage of subretinal fluid through defects in the retinal pigment epithelial layer's outer blood-retina barrier appears to occur secondary to choroidal abnormalities and dysfunction. The treatment of CSC is currently the subject of controversy, although recent data obtained from several large randomized controlled trials provide a wealth of new information that can be used to establish a treatment algorithm. Here, we provide a comprehensive overview of our current understanding regarding the pathogenesis of CSC, current therapeutic strategies, and an evidence-based treatment guideline for CSC. In acute CSC, treatment can often be deferred for up to 3-4 months after diagnosis; however, early treatment with either half-dose or half-fluence photodynamic therapy (PDT) with the photosensitive dye verteporfin may be beneficial in selected cases. In chronic CSC, half-dose or half-fluence PDT, which targets the abnormal choroid, should be considered the preferred treatment. If PDT is unavailable, chronic CSC with focal, non-central leakage on angiography may be treated using conventional laser photocoagulation. CSC with concurrent macular neovascularization should be treated with half-dose/half-fluence PDT and/or intravitreal injections of an anti-vascular endothelial growth factor compound. Given the current shortage of verteporfin and the paucity of evidence supporting the efficacy of other treatment options, future studies-ideally, well-designed randomized controlled trials-are needed in order to evaluate new treatment options for CSC.
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Affiliation(s)
- Helena M A Feenstra
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institution, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Hideki Koizumi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Susan M Downes
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Suzanne Yzer
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mark P Breazzano
- Retina-Vitreous Surgeons of Central New York, Liverpool, NY, USA; Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ramin Tadayoni
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Université de Paris, Paris, France
| | - Siegfried G Priglinger
- Department of Ophthalmology, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Laurenz J B Pauleikhoff
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Clemens A K Lange
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Roselie M H Diederen
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Reinier O Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Ocular Angiogenesis Group, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jay K Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Andrew J Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Department of Ophthalmology, New York University Grossman School of Medicine, New York, USA; Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
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Akilesh MS, Kumar V, Sinha A, Azad S, Chawla R, Vohra R, Venkatesh P. Ultra-wide field indocyanine green angiography in central serous chorioretinopathy. Indian J Ophthalmol 2024; 72:S606-S609. [PMID: 38770620 PMCID: PMC11338429 DOI: 10.4103/ijo.ijo_1852_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 05/22/2024] Open
Abstract
PURPOSE To study ultra-widefield indocyanine green angiography (ICGA) patterns in central serous chorioretinopathy (CSC). METHODS A cross-sectional observational study was undertaken on 30 patients aged 20 to 60 years with CSC at the retina clinic of a tertiary care center. Of them, 43 eyes were affected by CSC, whereas 17 eyes were unaffected as the bilateral disease was observed in 13 patients. All patients were evaluated for best-corrected visual acuity, intraocular pressure, detailed slit-lamp bio-microscopy, indirect ophthalmoscopy, ultra-widefield imaging for pseudo color photograph, fundus autofluorescence (FAF), fundus fluorescein angiography (FFA), and ICGA, and macular swept-source optical coherence tomography (SSOCT) characteristics. RESULTS The mean age of patients was 41.43 ± 8.81 years (range: 25-59 years). The median log MAR visual acuity in CSC eyes was 0.30 (range: 0.17-1.0), whereas it was 0 in non-CSC fellow eyes ( P < 0.001). Pachy-vessels and late hyperpermeability on ultra-widefield ICGA were observed in all eyes. Vortex vein anastomosis was present in 93% of the affected eyes versus 88.2% in unaffected fellow eyes ( P = 0.61). Disc and posterior poles were the sites of the maximum number of anastomoses in both affected and unaffected eyes ( P = 0.77). Asymmetry in vortex vein drainage of the macula was present in 88.4% of affected eyes and 88.2% of unaffected eyes. CONCLUSION Studying the ICGA findings in CSC patients emphasized the role of choroidal circulation in pathogenesis as Pachy vessels were observed in all eyes affected with CSC and even fellow eyes of patients. Vortex vein anastomosis around the disc or posterior pole and asymmetric drainage from the macula were noted and could be contributing to CSC pathology.
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Affiliation(s)
- MS Akilesh
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ayushi Sinha
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shorya Azad
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rajpal Vohra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Venkatesh
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Demirel S, Ayaz RE, Yanık Ö, Batıoğlu F, Özmert E, Iovino C, Chhablani J. Quantitative assessment of intervortex anastomosis in central serous chorioretinopathy and fellow eyes: Does the size of anastomotic vessels matter for the diagnosis? Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06517-7. [PMID: 38789795 DOI: 10.1007/s00417-024-06517-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 04/21/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
PURPOSE To evaluate the frequency and size of intervortex anastomosis at the posterior pole on en-face spectral domain optical coherence tomography (SD-OCT) images in central serous chorioretinopathy (CSC) cases and their fellow eyes and its associations with choroidal morphology. METHODS Sixty-five treatment-naive eyes of 65 patients with CSC, 65 fellow eyes, and 55 eyes of healthy age-matched participants were included. The presence of intervortex anastomosis at the watershed zone and asymmetry of the choroidal vessels between the superior and inferior macula were evaluated using 6 × 6 mm en-face SD-OCT. The diameter of the widest Haller vessel and the diameter of the widest anastomotic Haller vessel passing through the watershed zone were measured on en-face SD-OCT images. The choroidal vascularity index (CVI) was assessed using ImageJ software. RESULTS Intervortex vein anastomosis on the horizontal watershed zone was detected in 75.4% diseased eyes, 61.5% in fellow eyes, and 36.4% in healthy age-matched controls (p < 0.001). The mean CVI was significantly higher in both diseased (74.3 ± 2.3%) and fellow (73.8 ± 2.2%) eyes of CSC cases than in healthy controls (72.5 ± 2.3%) (p = 0.002, p = 0.013, respectively). In the cases with intervortex vein anastomosis, the diameter of the widest anastomotic Haller vessel passing through the watershed zone was 0.40 ± 0.10 mm in diseased eyes, 0.35 ± 0.11 mm in fellow eyes, and 0.30 ± 0.09 mm in healthy age-matched controls (p = 0.001). CONCLUSIONS Intervortex anastomosis might be seen as a variation in normal eyes, however, its frequency and the size of anastomotic vessels are significant higher in not only CSC but also in fellow eyes.
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Affiliation(s)
- Sibel Demirel
- Department of Ophthalmology, Ankara University School of Medicine, Vehbi Koç Eye Hospital, Mamak Street, Dikimevi, Ankara, Turkey.
| | - Rabia Eroğlu Ayaz
- Department of Ophthalmology, Marmara University Pendik Training and Research Hospital, Ankara, Turkey
| | - Özge Yanık
- Department of Ophthalmology, Ankara University School of Medicine, Vehbi Koç Eye Hospital, Mamak Street, Dikimevi, Ankara, Turkey
| | - Figen Batıoğlu
- Department of Ophthalmology, Ankara University School of Medicine, Vehbi Koç Eye Hospital, Mamak Street, Dikimevi, Ankara, Turkey
| | - Emin Özmert
- Department of Ophthalmology, Ankara University School of Medicine, Vehbi Koç Eye Hospital, Mamak Street, Dikimevi, Ankara, Turkey
| | - Claudio Iovino
- Eye Clinic, Multidisciplinary Department of Medical Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
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Liu P, Fang H, An G, Jin B, Lu C, Li S, Yang F, Du L, Jin X. Chronic Central Serous Chorioretinopathy in Elderly Subjects: Structure and Blood Flow Characteristics of Retina and Choroid. Ophthalmol Ther 2024; 13:321-335. [PMID: 37966697 PMCID: PMC10776535 DOI: 10.1007/s40123-023-00849-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION With advancements in imaging technology, researchers have been able to identify more distinctive imaging features of central serous chorioretinopathy (CSC). However, existing research primarily concentrates on young patients aged 50 years and below, leaving a dearth of studies on elderly CSC patients. Previous studies indicate that elderly CSC patients may exhibit unique imaging characteristics and have a clinical prognosis that significantly differs from younger patients. This study aimed to evaluate the characteristics of retina, choroid structure, and blood flow in elderly patients with chronic CSC (cCSC) examined multimode imaging and try to find new pathogenesis information of it. METHODS Using a cut-off age of 50 years, patients with chronic central serous chorioretinopathy were divided into two groups: older and younger. The control group consisted of 40 healthy individuals, with their right eyes assigned. Various clinical features were recorded, including the incidence of ellipsoid zone rupture (EZ-), fibrin in the subretinal fluid (SRF), pachydrusen, subretinal drusenoid deposits (SDD), pigment epithelial detachment (PED), double-layer sign (DLS), and choroidal lipid globule cavern. Measurements were taken for the thickness of the outer nuclear layer (ONL), the length of the extended outer photoreceptor segment (POS), the height and width of SRF, the vascular density of each layer of the retinal capillary plexus, the central macular thickness (CMT), and the subfoveal choroidal thickness (SFCT). RESULTS The proportion of females in the elderly group (43.75%) was significantly higher than that in the youth group (22.41%) (p = 0.034). The degree of hyperopia in the elderly group (1.03 ± 0.73) was higher than that in the youth group (0.26 ± 1.06), with a significant difference in BCVA (p = 0.05). The thickness of SFCT, CMT, ONL in the elderly group, and the length of photoreceptor outer segment in the elderly group were thinner than those in the youth group (p < 0.05). Choroidal capillary perfusion area (CCPA), macular area, and paramacular area were lower in the elderly group than those in the youth group in the full scan range (p < 0.05). The blood flow densities of deep capillary plexus (DCP), intermediate capillary plexus (ICP), and superficial capillary plexus (SCP) in the whole scan range, macular area, and paramacular area were lower in the elderly group than in the youth group, but the differences were not statistically significant. CONCLUSIONS In conclusion, our data suggest that elderly patients with cCSC may experience different disease outcomes. Elderly cCSC patients exhibit less gender bias, poorer vision, more severe structural damage and ischemia in the choroid and retina, and have a higher risk of developing choroidal neovascularization.
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Affiliation(s)
- Pei Liu
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China
- Henan Eye Hospital, Zhengzhou, 450000, China
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China
| | - Haixin Fang
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China
- Henan Eye Hospital, Zhengzhou, 450000, China
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China
| | - Guangqi An
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China
- Henan Eye Hospital, Zhengzhou, 450000, China
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China
| | - Bo Jin
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China
- Henan Eye Hospital, Zhengzhou, 450000, China
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China
- Fundus Disease Institute of Zhengzhou University, Zhengzhou, 450000, China
| | - Chenyu Lu
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China
- Henan Eye Hospital, Zhengzhou, 450000, China
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China
| | - Shu Li
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China
- Henan Eye Hospital, Zhengzhou, 450000, China
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China
| | - Fan Yang
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China
- Henan Eye Hospital, Zhengzhou, 450000, China
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China
| | - Liping Du
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China.
- Henan Eye Hospital, Zhengzhou, 450000, China.
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China.
- Fundus Disease Institute of Zhengzhou University, Zhengzhou, 450000, China.
| | - Xuemin Jin
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, 450000, China.
- Henan Eye Hospital, Zhengzhou, 450000, China.
- Academy of Medical Science of Zhengzhou University, Zhengzhou, 450000, China.
- Fundus Disease Institute of Zhengzhou University, Zhengzhou, 450000, China.
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9
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Matsumoto H, Hoshino J, Nakamura K, Kishi S, Akiyama H. Attenuation of irradiated choroid and its regional vortex veins in central serous chorioretinopathy after photodynamic therapy. Sci Rep 2023; 13:19903. [PMID: 37963949 PMCID: PMC10646078 DOI: 10.1038/s41598-023-47325-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/12/2023] [Indexed: 11/16/2023] Open
Abstract
We retrospectively studied 12 eyes of 12 patients with central serous chorioretinopathy (CSC) to investigate choroidal thickness changes following half-fluence photodynamic therapy (PDT) using widefield choroidal thickness maps obtained by optical coherence tomography (OCT). Additionally, we assessed the relationship between choroidal thickness changes and the regional vortex veins as visualized on widefield en face OCT of the choroid. Pre-treatment en face images of the choroidal vasculature were superimposed on subtracted choroidal thickness maps before and 3 months after half-fluence PDT. The choroidal thickness decreased mainly in the irradiated macular area and in the region of vortex veins which function as drainage for the macula in all eyes. Eleven eyes (91.7%) showed choroidal thinning in the nasal area which overlapped with the nasal vortex vein distribution. Moreover, in 10 (90.9%) of those eyes, we observed intervortex venous anastomosis across the vertical watershed zone. Quantitative analysis revealed that the reduction in choroidal thickness was most pronounced in the macular area. Furthermore, the choroidal thickness reduction in the area with macular drainage vortex veins was significantly greater than that in the area without such vortex veins. These results suggest that half-fluence PDT might decrease choroidal thickness due to choriocapillaris occlusion in the irradiated macula, possibly leading to diminished venous drainage from the macula to regional vortex veins. Moreover, venous blood flow through the anastomotic vessels from the macular drainage vortex veins into the nasal vortex veins might be reduced post-treatment.
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Affiliation(s)
- Hidetaka Matsumoto
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi, Maebashi, Gunma, 371-8511, Japan.
| | - Junki Hoshino
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Kosuke Nakamura
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Shoji Kishi
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Hideo Akiyama
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
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10
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Xia Y, Li X, Zhang J, Xie X. Choroidal vascularity index in different types of central serous chorioretinopathy: A meta-analysis. PLoS One 2023; 18:e0289186. [PMID: 37498843 PMCID: PMC10374115 DOI: 10.1371/journal.pone.0289186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023] Open
Abstract
PURPOSE To evaluate the choroidal vascularity index (CVI) in different types of central serous chorioretinopathy (CSC), healthy control eyes, and fellow eyes. METHODS Relevant studies published up to January 2023 were identified by searching multiple databases, including PubMed, Embase, Web of Science, Cochrane Library, and China National Knowledge Infrastructure (CNKI). Studies investigating the difference in CVI between CSC and control eyes were included. Data from these studies were analyzed using Stata (version 17) software. Weighted mean difference (WMD) and 95% confidence interval (95%CI) were calculated for the CVI in CSC eyes, control eyes, and fellow eyes. RESULTS The meta-analysis included 15 studies, with 213 acute CSC eyes, 153 chronic CSC eyes, 92 uncategorized CSC eyes, 40 resolved CSC eyes, 409 eyes of normal healthy controls, and 318 fellow eyes. The result revealed that CVI was higher in acute CSC eyes (WMD = 5.40, 95%CI = 2.36-8.44, P = 0.001) compared to control eyes. Also, CVI in chronic CSC eyes was higher than in control eyes (WMD = 1.26, 95%CI = 0.03-2.49, p = 0.046). The fellow eyes of acute CSC had a higher CVI when compared to control eyes (WMD = 2.53, 95%CI = 0.78-4.28, p = 0.005). There was no significant difference in CVI between acute and chronic CSC eyes (WMD = 0.75, 95%CI = -0.31-1.82, P = 0.167). In the sub-analysis based on the area selected for CVI calculation, the WMDs in the whole image subgroups were lower than the main analysis for the comparisons of fellow eyes of acute CSC and control eyes, acute CSC eyes and control eyes, and acute CSC eyes and fellow eyes. In the macular area subgroups, the WMDs were higher than in the whole image subgroups, suggesting a potential regional variation of CVI in CSC eyes. CONCLUSIONS The results demonstrated that CVI is increased in CSC eyes and fellow eyes of acute CSC. There is no significant difference in CVI between acute and chronic CSC eyes. The area selected for CVI calculation can influence the outcome, which requires further clinical research to clarify.
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Affiliation(s)
- Yihao Xia
- Eye School of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xiaodong Li
- The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
| | - Jiaqi Zhang
- Eye School of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xuejun Xie
- Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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11
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Nishigori N, Muraoka Y, Ishikura M, Kogo T, Ueda-Arakawa N, Miyata M, Tamura H, Hata M, Takahashi A, Miyake M, Tsujikawa A. Extensive reduction in choroidal thickness after photodynamic therapy in eyes with central serous chorioretinopathy. Sci Rep 2023; 13:10890. [PMID: 37407690 DOI: 10.1038/s41598-023-37802-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/28/2023] [Indexed: 07/07/2023] Open
Abstract
We examined the effect of reduced fluence (rf)-photodynamic therapy (PDT) of the macular area on the wide-field choroidal thickness in 20 eyes with central serous chorioretinopathy (CSC) and 20 age- and sex-matched control eyes. The choroidal thickness at the posterior pole was measured before and after rf-PDT, using a grid with inner and outer rings, each divided into superotemporal, inferotemporal, superonasal, and inferonasal quadrants, respectively, making up a total of nine subfields including the central 3 mm ring. Before treatment, all eyes showed wide-field choroidal thickening from the dilated vortex vein ampulla to the fovea, along the course of the vein. After rf-PDT of the macular area, the choroidal thickness significantly decreased, not only in the irradiated macular area but also outside the arcade vessels in all quadrants (p < 0.001 for all inner subfields; p = 0.035 and p = 0.024 for the outer superonasal and inferonasal subfields, respectively; p < 0.001 and p = 0.004 for the outer superotemporal and inferotemporal subfields, respectively). For control eyes, the choroidal thickness did not differ between the initial visit and follow-up 1.2 ± 0.7 months after the initial visit (p > 0.05 for all subfields). These findings provide new insights into the pathogenesis of CSC and explain the reasons for the effectiveness of rf-PDT for this condition.
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Affiliation(s)
- Naomi Nishigori
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Masaharu Ishikura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takahiro Kogo
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Naoko Ueda-Arakawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Manabu Miyata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroshi Tamura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masayuki Hata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Ayako Takahashi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan
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12
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Hwang BE, Kim JY, Kim RY, Kim M, Park YG, Park YH. En-face optical coherence tomography hyperreflective foci of choriocapillaris in central serous chorioretinopathy. Sci Rep 2023; 13:7184. [PMID: 37137948 PMCID: PMC10156712 DOI: 10.1038/s41598-023-33800-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/19/2023] [Indexed: 05/05/2023] Open
Abstract
The purpose of this study is to evaluate choroidal hyperreflective foci (HRF) changes in central serous chorioretinopathy (CSC) on en-face optical coherence tomography (OCT). Retrospective analysis of 42 patients with unilateral CSC (84 eyes, including fellow eyes for controls) and 42 age- and sex-matched controls. With 4.5 × 4.5 mm macular scans, structural en-face OCT choriocapillaris (CC) slabs were used to calculate the density and number of HRF in acute CSC eyes with serous retinal detachment (SRD), resolved CSC eyes without SRD, unaffected fellow eyes, control eyes, and 1-year follow-up eyes. Based on the 2-disc diameter (3000 μm), the en-face OCT scan was divided into foveal and perifoveal lesion and analyzed to consider the impact of SRF in HRF measurement. Regression analyses were performed on the several factors with HRF number and density in the acute and resolved CSC eyes. The perifoveal density and number of CC HRF was significantly lower in the resolved CSC eyes when compared to the acute CSC eyes (P = 0.002, both), fellow eyes (P = 0.042/density, 0.028/number), and controls (P = 0.021/density, P = 0.003/number). There was no significant difference between the acute CSC eyes, fellow eyes, controls, and 1-year follow-up eyes. As subfoveal choroidal thickness decreased and choroidal vascularity (CVI) increased, the perifoveal density and number of HRF was measured higher with a significant correlation in univariate regression analysis of the acute and resolved CSC eyes (all, P < 0.05). The authors hypothesized that stromal edema induced by choroidal congestion and hyperpermeability has the greatest influence on HRF measurement, possibly affected by inflammatory cells and materials extravasation.
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Affiliation(s)
- Bo-Een Hwang
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joo-Young Kim
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Rae-Young Kim
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mirinae Kim
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Geun Park
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Hoon Park
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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13
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Lee PK, Ra H, Han SY, Baek J. QUANTITATIVE ANALYSIS OF CHOROIDAL MORPHOLOGY USING MULTIMODAL IMAGING IN ACUTE AND PERSISTENT CENTRAL SEROUS CHORIORETINOPATHY. Retina 2023; 43:832-840. [PMID: 36727765 DOI: 10.1097/iae.0000000000003715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To analyze quantitative differences in choroidal morphology between acute and persistent central serous chorioretinopathy using multimodal images. METHODS Ultra-widefield indocyanine green angiography (UWICGA) and optical coherence tomography images of 72 eyes of 72 patients with acute (32 eyes) and persistent (40 eyes) central serous chorioretinopathy were collected. Choroidal thickness, area, vessel density, symmetry, and intervortex anastomosis were assessed. RESULTS The choroidal area on optical coherence tomography B-scan images was smaller and the choroidal vessel density on UWICGA images was lower in the persistent group ( P < 0.001 and P = 0.028, respectively). Choroidal vessel density on UWICGA showed positive correlation with that of vortex ampullae (all P ≤ 0.046). The constitution of the intervortex anastomosis and dominant vessels in the macular area showed differences between the groups ( P = 0.014 and P = 0.010, respectively), with greater inferonasal vessel participation in the anastomosis and combined superotemporal and inferotemporal vessels as dominant vessels in the persistent groups. CONCLUSION Acute and persistent central serous chorioretinopathy differed in subfoveal choroidal area, choroidal vessel density, and intervortex anastomosis constitution on UWICGA images. Choroidal vessel density on UWICGA images correlated with that of vortex ampullae. These findings enhance our understanding of the pathophysiology of central serous chorioretinopathy subtypes.
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Affiliation(s)
- Phil-Kyu Lee
- Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Gyeonggi-do, Republic of Korea; and
| | - Ho Ra
- Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Gyeonggi-do, Republic of Korea; and
| | - Su Yeon Han
- Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Gyeonggi-do, Republic of Korea; and
| | - Jiwon Baek
- Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Gyeonggi-do, Republic of Korea; and
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Bucheon, Seoul, Republic of Korea
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14
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Keidel LF, Schworm B, Langer J, Luft N, Herold T, Hagenau F, Klaas JE, Priglinger SG, Siedlecki J. Scleral Thickness as a Risk Factor for Central Serous Chorioretinopathy and Pachychoroid Neovasculopathy. J Clin Med 2023; 12:jcm12093102. [PMID: 37176543 PMCID: PMC10179194 DOI: 10.3390/jcm12093102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/17/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
In the pathophysiology of central serous chorioretinopathy (CSC), scleral changes inducing increased venous outflow resistance are hypothesized to be involved. This work aims to investigate anterior scleral thickness (AST) as a risk factor for pachychoroid disorders. A randomized prospective case-control study was performed at the Ludwig Maximilians University, Department of Ophthalmology. In patients with CSC or pachychoroid neovasculopathy (PNV) and in an age- and refraction-matched control group, swept source optical coherence tomography (SS-OCT) was used to measure anterior scleral thickness (AST). Subfoveal choroidal thickness (SFCT) was assessed using enhanced depth imaging OCT (EDI-OCT). In total, 46 eyes of 46 patients were included in this study, with 23 eyes in the CSC/PNV and 23 eyes in the control group. A significantly higher AST was found in the CSC/PNV compared with the control group (403.5 ± 68.6 (278 to 619) vs. 362.5 ± 62.6 (218 to 498) µm; p = 0.028). Moreover, the CSC/PNV group showed a higher SFCT (392.8 ± 92.8 (191-523) vs. 330.95 ± 116.5 (167-609) µm, p = 0.004). Compared with the age- and refraction-matched controls, patients with CSC and PNV showed a significantly thicker anterior sclera. Scleral thickness might contribute to the venous overload hypothesized to induce pachychoroid phenotypes.
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Affiliation(s)
- Leonie F Keidel
- Department of Ophthalmology, Ludwig-Maximilians-University, 80336 Munich, Germany
| | - Benedikt Schworm
- Department of Ophthalmology, Ludwig-Maximilians-University, 80336 Munich, Germany
| | - Julian Langer
- Department of Ophthalmology, Ludwig-Maximilians-University, 80336 Munich, Germany
| | - Nikolaus Luft
- Department of Ophthalmology, Ludwig-Maximilians-University, 80336 Munich, Germany
| | - Tina Herold
- Department of Ophthalmology, Ludwig-Maximilians-University, 80336 Munich, Germany
| | - Felix Hagenau
- Department of Ophthalmology, Ludwig-Maximilians-University, 80336 Munich, Germany
| | - Julian E Klaas
- Department of Ophthalmology, Ludwig-Maximilians-University, 80336 Munich, Germany
| | | | - Jakob Siedlecki
- Department of Ophthalmology, Ludwig-Maximilians-University, 80336 Munich, Germany
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15
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B. Brown R, Mohan S, Chhablani J. Pachychoroid Spectrum Disorders: An Updated Review. J Ophthalmic Vis Res 2023; 18:212-229. [PMID: 37181617 PMCID: PMC10172805 DOI: 10.18502/jovr.v18i2.13188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/12/2023] [Indexed: 05/16/2023] Open
Abstract
Pachychoroid disease spectrum is a recent term that has been associated with an increasing number of phenotypes. This review discusses updated findings for each of the typical pachychoroid entities (central serous chorioretinopathy, pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy, peripapillary pachychoroid syndrome, and focal choroidal excavation), as well as two relatively new additions (peripapillary pachychoroid neovasculopathy and peripheral exudative hemorrhagic chorioretinopathy). Here, we discuss the potential pathogenic mechanisms for these diseases and relevant imaging updates. Finally, we argue for a consistent classification scheme for these entities.
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Affiliation(s)
- Richard B. Brown
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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16
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Quadrant laser photocoagulation trial to ameliorate choroidal congestion in central serous chorioretinopathy. Jpn J Ophthalmol 2023; 67:156-163. [PMID: 36735098 DOI: 10.1007/s10384-023-00976-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/21/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To investigate the efficacy and safety of quadrant laser photocoagulation to ameliorate the choroidal congestion in central serous choroidopathy (CSC). STUDY DESIGN Historically controlled study. METHODS We prospectively studied 20 eyes with acute CSC in the quadrant laser group, in which laser photocoagulation was applied to the macular leakage point(s) as well as the quadrant of the fundus showing vortex vein dilatation. Central choroidal thickness (CCT), vertical diameter of dilated vortex vein, resolution rate of serous retinal detachment (SRD), and visual field were evaluated post-treatment. We also compared the results with those of 18 retrospectively analyzed eyes with acute CSC in an external control group, in which laser photocoagulation had been applied only to the macular leakage point(s). RESULTS In the quadrant laser group, 2 eyes were excluded from data analysis due to choroidal neovascularization (CNV). CCT was significantly reduced in both groups, but more significantly in the quadrant laser group. The vertical diameter of the dilated vortex vein was significantly decreased only in the quadrant laser group. The resolution rate of SRD was similar in the two groups. In the quadrant laser group, 8 eyes (44.4%) showed mild deterioration of the visual field, consistent with the area subjected to quadrant laser photocoagulation. CONCLUSION Quadrant laser photocoagulation can have limited efficacy for ameliorating vortex vein congestion in CSC. When laser photocoagulation to the macular area is combined with quadrant laser photocoagulation, attention must be paid to the possible development of CNV and visual field deterioration.
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Retinal Pigment Epithelial Abnormality and Choroidal Large Vascular Flow Imbalance Are Associated with Choriocapillaris Flow Deficits in Age-Related Macular Degeneration in Fellow Eyes. J Clin Med 2023; 12:jcm12041360. [PMID: 36835897 PMCID: PMC9965486 DOI: 10.3390/jcm12041360] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
Choriocapillaris flow deficits detected on optical coherence tomography angiographs were retrospectively analyzed. In 38 age-related macular degeneration (AMD) fellow eyes, without fundus findings (26 men, 71.7 ± 1.9 years old), and 22 control eyes (11 men, 69.4 ± 1.8), the choriocapillaris flow area (CCFA) ratio and coefficient of variation (CV) of the CCFA ratio (which represented the heterogeneity of the ratio), negatively and positively correlated with age (all p < 0.01), respectively. Moreover, the respective mean values were lower (p = 0.0031) and greater (p = 0.002) in AMD fellow eyes than in the control eyes. The high-risk condition of AMD fellow eyes was defined by a CCFA ratio <58.5%, and the CV of the CCFA ratio ≥0.165 (odds ratio (OR), 5.408; 95% confidence interval (CI): 1.117-21.118, p = 0.035, after adjusting for age and sex) was related to the presence of fundus autofluorescence abnormality (OR, 16.440; 95% CI, 1.262-214.240; p = 0.033) and asymmetrically dilated choroidal large vasculature (OR, 4.176; 95% CI, 1.057-16.503; p = 0.042), after adjusting for age and sex. The presence of fundus autofluorescence abnormality indicated a retinal pigment epithelium (RPE) abnormality. The RPE volume was reduced in the latter eye group, particularly in the thinner choroidal vasculature. In addition to aging, RPE abnormality and choroidal large vascular flow imbalances were associated with exacerbated heterogeneous choriocapillaris flow deficits in AMD fellow eyes without macular neovascularization.
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Brinks J, van Dijk EHC, Meijer OC, Schlingemann RO, Boon CJF. Choroidal arteriovenous anastomoses: a hypothesis for the pathogenesis of central serous chorioretinopathy and other pachychoroid disease spectrum abnormalities. Acta Ophthalmol 2022; 100:946-959. [PMID: 35179828 PMCID: PMC9790326 DOI: 10.1111/aos.15112] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 12/30/2022]
Abstract
The pachychoroid disease spectrum (PDS) includes several chorioretinal diseases that share specific choroidal abnormalities. Although their pathophysiological basis is poorly understood, diseases that are part of the PDS have been hypothesized to be the result of venous congestion. Within the PDS, central serous chorioretinopathy is the most common condition associated with vision loss, due to an accumulation of subretinal fluid in the macula. Central serous chorioretinopathy is characterized by distinct risk factors, most notably a high prevalence in males and exposure to corticosteroids. Interestingly, sex differences and corticosteroids are also strongly associated with specific types of arteriovenous anastomoses in the human body, including dural arteriovenous fistula and surgically created arteriovenous shunts. In this manuscript, we assess the potential of such arteriovenous anastomoses in the choroid as a causal mechanism of the PDS. We propose how this may provide a novel unifying concept on the pathophysiological basis of the PDS, and present cases in which this mechanism may play a role.
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Affiliation(s)
- Joost Brinks
- Department of OphthalmologyLeiden University Medical CentreLeidenThe Netherlands
| | - Elon H. C. van Dijk
- Department of OphthalmologyLeiden University Medical CentreLeidenThe Netherlands
| | - Onno C. Meijer
- Department of Medicine, Division of Endocrinology and MetabolismLeiden University Medical CentreLeidenThe Netherlands
| | - Reinier O. Schlingemann
- Department of Ophthalmology, Amsterdam University Medical CentresUniversity of AmsterdamAmsterdamThe Netherlands
- Department of OphthalmologyUniversity of Lausanne, Jules‐Gonin Eye Hospital, Fondation Asile des AveuglesLausanneSwitzerland
| | - Camiel J. F. Boon
- Department of OphthalmologyLeiden University Medical CentreLeidenThe Netherlands
- Department of Ophthalmology, Amsterdam University Medical CentresUniversity of AmsterdamAmsterdamThe Netherlands
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Park JB, Kim K, Kang MS, Kim ES, Yu SY. Central serous chorioretinopathy: Treatment. Taiwan J Ophthalmol 2022; 12:394-408. [PMID: 36660123 PMCID: PMC9843567 DOI: 10.4103/2211-5056.362040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/12/2022] [Indexed: 11/29/2022] Open
Abstract
Central serous chorioretinopathy (CSC) is a pachychoroid spectrum disease characterized by serous detachment of the neurosensory retina with subretinal fluid in young and middle-aged adults. The pathogenesis of CSC is not yet fully understood. However, it is considered a multifactorial disease that is strongly associated with choroidal dysfunction or vascular engorgement. Although there is no consensus on the treatment of CSC, photodynamic therapy has been effectively used to manage serous retinal detachment (SRD) in CSC. Moreover, micropulse diode laser photocoagulation and focal laser treatment have also been used. Recently, oral medications, including mineralocorticoid receptor antagonists, have been proposed for the management of CSC. Multimodal imaging plays a significant role in the diagnosis and treatment of CSC. Optical coherence tomography angiography (OCTA) has the advantage of detecting vascular flow in the retina and choroid layer, allowing for a better understanding of the pathology, severity, prognosis, and chronicity of CSC. In addition, early detection of choroidal neovascularization in CSC is possible using OCTA. This review article aims to provide a comprehensive and updated understanding of CSC, focusing on treatment.
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Affiliation(s)
- Jong Beom Park
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Kiyoung Kim
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Min Seok Kang
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Eung Suk Kim
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Seung-Young Yu
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea,Address for correspondence: Prof. Seung-Young Yu, Department of Ophthalmology, Kyung Hee University Hospital, 23, Kyungheedae-ro, Dongdaemun-Gu, Seoul 02447, Korea. E-mail:
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20
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Hwang BE, Kwak JH, Kim JY, Kim RY, Kim M, Park YG, Park YH. Serial choriocapillaris flow changes in eyes with branched retinal vascular obstruction (BRVO). PLoS One 2022; 17:e0277988. [PMID: 36399455 PMCID: PMC9674129 DOI: 10.1371/journal.pone.0277988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate the choriocapillaris (CC) flow changes in branched retinal vascular obstruction (BRVO) on optical coherence tomography angiography (OCTA). METHODS Retrospective analysis of 29 patients with unilateral BRVO (58 eyes, including unaffected fellow eyes for controls). 4.5 x 4.5 mm macular scans were divided into 4 quadrants. Serial analyses were conducted on CC flow voids of the opposite quadrant to the active occluded area in BRVO eyes. Each of the quadrants were also compared to the occluded quadrant of resolved eyes and the contralateral quadrant of fellow eyes by matched data analysis. A regression analysis was performed on the several parameters (Choroidal thickness; CT, Choroidal vascularity index; CVI, Central macular thickness; CMT, The number of intravitreal injections) and CC flow voids. RESULTS The CC flow void increased sequentially: The uninvolved quadrant of acute BRVO-affected eyes, that of resolved eyes after 3-month/1-year, the contralateral quadrant of fellow eye, the involved (occluded) quadrant of resolved eyes. There were significant correlations between initial CMT, the number of injections and the CC flow void of uninvolved quadrants (P = 0.025, 0.031, respectively), and between the involved (occluded) quadrants and fellow CT (P = 0.029). CONCLUSION CC flow void of uninvolved macular areas decreased significantly in eyes with acute BRVO, suggesting that CC changes were limited to the blocked area and a compensatory mechanism would work in surrounding areas.
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Affiliation(s)
- Bo-Een Hwang
- Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Hyuck Kwak
- Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joo-Young Kim
- Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Rae-Young Kim
- Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mirinae Kim
- Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young-Geun Park
- Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young-Hoon Park
- Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
- * E-mail:
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21
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Quantitative analysis of choroidal vasculature in central serous chorioretinopathy using ultra-widefield swept-source optical coherence tomography angiography. Sci Rep 2022; 12:18427. [PMID: 36319689 PMCID: PMC9626581 DOI: 10.1038/s41598-022-23389-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
We aimed to quantitatively compare the choroid blood flow and choroid thickness at the periphery among eyes with central serous chorioretinopathy (CSC), fellow eyes and healthy eyes using ultra-widefield swept-source optical coherence tomography angiography (UWF SS-OCTA). Retrospective analysis of 49 patients with CSC (98 eyes, including unaffected fellow eyes) and 49 age and sex matched controls were included. We obtained 3-dimensional data of vertical 20 mm × horizontal 24 mm × scan depth 6 mm, comprising 9 subfields (superotemporal, upper, superonasal, temporal, central, nasal, inferotemporal, lower, inferonasal regions). CSC eyes presented with greater density of large-vessel choroidal layer in all the 9 subfields compared with controls. Compared with normal eyes, CSC eyes had greater choroidal thickness (superotemporal, upper, superonasal, temporal, central, nasal, inferotemporal, and inferonasal subfields) and choroidal volume (superotemporal, upper, superonasal, temporal, central, and nasal subfields). Compared with control eyes, the choriocapillaris density in the superotemporal, inferotemporal and inferonasal subfields was greater in patients with CSC. Our study may provide further evidence for the congestion of vortex vein in the pathogenesis of CSC. UWF SS-OCTA can be used to evaluate the abnormalities of the choroidal structures even at the periphery in eyes with CSC.
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22
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Meng Y, Xu Y, Li L, Su Y, Zhang L, Chen C, Yi Z. Wide-field OCT-angiography assessment of choroidal thickness and choriocapillaris in eyes with central serous chorioretinopathy. Front Physiol 2022; 13:1008038. [PMID: 36338482 PMCID: PMC9634072 DOI: 10.3389/fphys.2022.1008038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/06/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose: To assess wide-field changes in choroidal thickness and choriocapillaris in eyes with central serous chorioretinopathy (CSC) compared with the fellow eyes and eyes from healthy individuals using wide-field swept-source (SS) OCT-Angiography (OCTA). Methods: A cross-sectional study in which 68 eyes from 34 individual patients affected by unilateral CSC and 32 eyes of 32 age- and sex-matched healthy subjects were evaluated. All subjects underwent wide-field SS-OCTA examination to quantify choroidal thickness and vascular density of the choriocapillaris. To assess the wide-field changes, we developed five 4-by-4 mm square regions located in the posterior pole and in the four quadrants of the peripheral retina (superotemporal, inferotemporal, superonasal, and inferonasal subfields, respectively). Results: The choroidal thickness of eyes with CSC was greater than that of the fellow eyes in the central and inferonasal subfields (p < 0.001 for the central subfield and p = 0.006 for the inferonasal subfield, respectively). Compared with the choroidal thickness of healthy eyes, that of patients with CSC were significantly greater in all the subfields (p < 0.05 for the fellow eyes and p < 0.05 for eyes with CSC, respectively). Compared with that of healthy eyes, the vascular density of choriocapillaris in eyes of patients with CSC were significantly greater in the central and superotemporal subfields (p < 0.05 for the fellow eyes and p < 0.05 for eyes with CSC, respectively). In the central region, the vascular density of choriocapillaris of the fellow eyes was greater than eyes with CSC (p = 0.023). Conclusion: CSC appears to be a bilateral disease with asymmetric manifestations. Local factors of the diseased eyes may play an important role in the development of CSC, during which dynamic and regional changes in the choriocapillaris may have happened. Wide-field swept-source OCTA provided a useful tool to study the pathogenesis of CSC.
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Affiliation(s)
- Yang Meng
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yishuang Xu
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lu Li
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yu Su
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lu Zhang
- Department of Ophthalmology, The Central Hospital of Wuhan, Wuhan, China
| | - Changzheng Chen
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
- *Correspondence: Changzheng Chen, ; Zuohuizi Yi,
| | - Zuohuizi Yi
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
- *Correspondence: Changzheng Chen, ; Zuohuizi Yi,
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23
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Kang HG, Woo SJ, Lee JY, Cho HJ, Ahn J, Yang YS, Jo YJ, Kim SW, Kim SJ, Sagong M, Lee JJ, Kang M, Park HS, Byeon SH, Kim SS, Kang SW, Park KH, Lee CS. Pathogenic Risk Factors and Associated Outcomes in the Bullous Variant of Central Serous Chorioretinopathy. Ophthalmol Retina 2022; 6:939-948. [PMID: 35476957 DOI: 10.1016/j.oret.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE To compare the clinical features, treatments, and outcomes between bullous and chronic variants of central serous chorioretinopathy (CSC). DESIGN Retrospective, observational case series. PARTICIPANTS Sixty-two eyes of 44 patients with bullous-variant CSC (bvCSC) and 97 eyes of 85 patients with nonbullous CSC. METHODS We conducted a national survey between September 1, 2020, and March 31, 2021, of members of the Korean Retina Society and obtained data of patients with bvCSC from 11 retinal centers. A comparator group comprised consecutive chronic CSC patients without bullous detachment. MAIN OUTCOME MEASURES Baseline demographics and patient characteristics were compared between groups. Secondary outcomes included factors associated with visual prognosis within the bvCSC group. RESULTS Compared with the nonbullous CSC group, the bvCSC group presented at a younger age (49 vs. 52 years; P = 0.047) and with more bilateral involvement (41% vs. 14%; P < 0.001). Systemic corticosteroid use was more prevalent in the bvCSC group, both in terms of any exposure (50% vs. 20%; P = 0.001) and long-term exposure (36% vs. 9%; P < 0.001). The bvCSC group had distinct imaging features (all P < 0.05): retinal folding (64% vs. 1%), subretinal fibrin (75% vs. 13%), multiple retinal pigment epithelium tears (24% vs. 2%), and multifocal fluorescein leakages with terminal telangiectasia (36% vs. 1%). Although bvCSC patients had worse vision at diagnosis (20/80 vs. 20/44; P = 0.003), treatment response was more robust (fluid resolution by final follow-up, 84% vs. 68%; P = 0.034) even with conservative management, resulting in similar final vision (20/52 vs. 20/45; P = 0.52). History of kidney-related (odds ratio [OR] 5.4; 95% confidence interval [CI] 1.3-18.5; P = 0.045) and autoimmune/rheumatoid diseases (OR 25.4, 95% CI 2.8-195.0; P = 0.004) showed associations with the bvCSC group. Apart from vision at diagnosis (OR 0.1, 95% CI 0.05-0.36; P < 0.001), a history of renal transplantation was most predictive of visual prognoses for bvCSC eyes (OR 0.2, 95% CI 0.04-0.75; P = 0.020). CONCLUSIONS Bullous-variant CSC may be associated with pathogenic risk factors based on underlying medical conditions and systemic corticosteroid use. Poor vision at diagnosis and history of renal transplantation were associated with poor visual outcome.
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Affiliation(s)
- Hyun Goo Kang
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Korea; Translational Genome Informatics Laboratory, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joo Yong Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Han Joo Cho
- Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Jeeyun Ahn
- Department of Ophthalmology, Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yun Sik Yang
- Department of Ophthalmology, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea
| | - Young-Joon Jo
- Department of Ophthalmology, Chungnam National University Hospital, Daejon, Korea
| | - Seong-Woo Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Sang Jin Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Sagong
- Department of Ophthalmology, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
| | - Jae Jung Lee
- Department of Ophthalmology, Pusan National University Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Minjae Kang
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Song Park
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Ishikura M, Muraoka Y, Nishigori N, Takahashi A, Miyake M, Ueda-Arakawa N, Miyata M, Ooto S, Tsujikawa A. Widefield Choroidal Thickness of Eyes with Central Serous Chorioretinopathy Examined by Swept-Source OCT. Ophthalmol Retina 2022; 6:949-956. [PMID: 35436598 DOI: 10.1016/j.oret.2022.04.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/31/2022] [Accepted: 04/11/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE To examine widefield (WF) changes in the choroidal thickness of eyes with central serous chorioretinopathy (CSC). DESIGN An observational study. PARTICIPANTS Twenty-two patients (20 men and 2 women) with treatment-naïve unilateral CSC and 28 normal eyes of 28 age-matched, healthy participants (21 men and 7 women). METHODS We performed enhanced depth imaging of swept-source (SS) OCT with a viewing angle of vertical 20 mm × horizontal 23 mm. Moreover, we developed a grid consisting of 9 subfields, with diameters of 3, 9, and 18 mm; the inner and outer rings were enclosed by circles with diameters of 3 and 9 mm and 9 and 18 mm, respectively, which were divided into 4 subfields-superotemporal, inferotemporal, superonasal, and inferonasal. MAIN OUTCOME MEASURES Widefield changes in choroidal thickness. RESULTS The mean duration from the presumed onset of CSC was 6.8 ± 3.1 months during the examination. Compared with that in normal eyes, the choroidal thickness in eyes of patients with CSC was significantly greater in all subfields (P < 0.020 for fellow eyes; P < 0.001 for eyes with CSC). Compared with that in fellow eyes, the choroidal thicknesses in eyes of patients with CSC were significantly greater, except for the outer superotemporal and inferonasal subfields (P < 0.001 for all inner subfields; P < 0.001 for the outer superonasal and inferotemporal subfields). In areas with dilated vortex veins, choroidal thickening was observed from the vicinity of the vortex vein ampulla to the macula along the course of the veins. Choroidal thickening on the dominant side was significantly greater than that on the nondominant side (P = 0.015 for the nasal subfield of the inner ring; P = 0.003 and P < 0.001 for the temporal subfields of the inner and outer rings, respectively). CONCLUSIONS Enhanced depth imaging of SS-OCT facilitated the analysis of WF changes in choroidal thickness in both healthy patients and patients with CSC. The local factors of the affected vortex vein and systemic risk factors may be involved in the pathogenesis of CSC.
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Affiliation(s)
- Masaharu Ishikura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Naomi Nishigori
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ayako Takahashi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naoko Ueda-Arakawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Manabu Miyata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sotaro Ooto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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25
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Tagawa M, Ooto S, Yamashiro K, Tamura H, Oishi A, Uji A, Miyata M, Miyake M, Takahashi A, Ichioka A, Tsujikawa A. Choriocapillaris flow deficit in a pachychoroid spectrum disease using en face optical coherence tomography angiography averaging. PLoS One 2022; 17:e0271747. [PMID: 36094941 PMCID: PMC9467345 DOI: 10.1371/journal.pone.0271747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/06/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose
To investigate the choriocapillaris changes associated with pachychoroid pigment epitheliopathy (PPE) in comparison with healthy eyes.
Methods
Nine 3 × 3 mm macular optical coherence tomography angiography images were acquired in patients with PPE and age-matched healthy participants. Multiple en face image averaging of the choriocapillaris was binarized for quantitative image analysis of the flow voids. In PPE eyes, we evaluated the presence of pachyvessels and the association between the location of the choriocapillaris flow deficit and pachyvessels.
Results
Thirty-two eyes with PPE and 30 eyes of healthy participants were included. In PPE eyes, the mean total area (1.16 ± 0.18 vs. 0.91 ± 0.16, p < 0.001) and average size of the flow voids (790 ± 144 vs. 520 ± 138; p < 0.001) were significantly larger than those in control eyes. Composite images of the choriocapillaris and choroid showed choriocapillaris flow deficits just above and outside the pachyvessels. The mean proportion of the flow void area overlying the pachyvessels against the whole flow void area of the choriocapillaris was 21.3% ± 10.2% (9.38%-44.42%) in PPE eyes.
Conclusions
In PPE eyes, the blood flow area of the choriocapillaris decreased diffusely within the macular area compared to control eyes, and the choriocapillaris flow deficit was not necessarily related to pachyvessel location.
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Affiliation(s)
- Miho Tagawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sotaro Ooto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- * E-mail:
| | - Kenji Yamashiro
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Hiroshi Tamura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akio Oishi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihito Uji
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Manabu Miyata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ayako Takahashi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ai Ichioka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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26
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Zeng Q, Luo L, Yao Y, Tu S, Yang Z, Zhao M. Three-dimensional choroidal vascularity index in central serous chorioretinopathy using ultra-widefield swept-source optical coherence tomography angiography. Front Med (Lausanne) 2022; 9:967369. [PMID: 36160148 PMCID: PMC9490028 DOI: 10.3389/fmed.2022.967369] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022] Open
Abstract
Background To map and compare the three-dimensional choroidal vascularity index (3D-CVI) in eyes with unilateral central serous chorioretinopathy (CSC), fellow eyes and control eyes using ultra-widefield swept source optical coherence tomography (UWF SS-OCTA). Methods In this prospective observational study, the 3D-CVIs were measured in 9 subfields or 1 × 1 mm grids by the UWF SS-OCTA with a viewing angle of horizontal 24 × vertical 20 mm. The proportions of vortex vein anastomoses and their corresponding CVI in the central regions were compared among the CSC, fellow and control eyes. Correlations of CVI and vascular density of the large choroidal vessel layer/choriocapillaris layer/choroidal thickness (CT) were also assessed. Results Thirty-two eyes in 32 patients with unilateral CSC and 32 normal eyes were included in the study. The mean CVI in the eyes with CSC was significantly greater than that in the fellow eyes of CSC and control eyes (41.99 ± 3.56% vs. 40.38 ± 3.855%, P = 0.003; 41.99 ± 3.56% vs. 38.93 ± 4.067%, P = 0.004, respectively). The CVIs in superotemporal, inferotemporal and inferonasal regions were significantly higher in CSC eyes than control eyes (P = 0.03, P = 0.02, P = 0.008). In CSC eyes, there was a linear positive correlation between 3D-CVI and vascular density of the large choroidal vessel layer and CT in all subfields. The proportion of vortex vein anastomoses in CSC was 25/32 (78.1%), and significantly higher in fellow and control eyes (P < 0.001). The average central CVI was significantly higher in CSC eyes with anastomoses than in CSC eyes without anastomoses (42.8 ± 5.1% vs. 38.4 ± 2.7%, P = 0.039). CVIs in superior, central, inferior, superonasal, nasal and inferonasal regions were significantly correlated with vortex vein anastomoses (P < 0.05), regardless of CSC, fellow or healthy eyes. In addition, whether there were vortex vein anastomoses, CVI in superotemporal region was significantly higher in eyes with CSC (P = 0.002) and fellow eyes (P = 0.014), compared to control eyes. No significant correlation was found between hypertension and CVIs in the three groups. Conclusion Remodeling of choroidal drainage routes by venous anastomosis between superior and inferior vortex veins may be common in CSC. The 3D-CVI could be a comprehensive parameter to evaluate the choroid vasculature and help understand the pathogenesis of pachychoroid spectrum disease.
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Affiliation(s)
- Qiaozhu Zeng
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Lan Luo
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Yuou Yao
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Shu Tu
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Zhi Yang
- TowardPi (Beijing) Medical Technology, Beijing, China
| | - Mingwei Zhao
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
- *Correspondence: Mingwei Zhao,
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Nishi O, Yasukawa T. Hydrodynamic Analysis of the Clinical Findings in Pachychoroid-Spectrum Diseases. J Clin Med 2022; 11:jcm11175247. [PMID: 36079175 PMCID: PMC9457415 DOI: 10.3390/jcm11175247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/16/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
We wish to demonstrate that theorems of fluid dynamics may be employed to hydrodynamically analyze the clinical presentations seen within the pachychoroid-spectrum diseases (PSD). Methods: We employed both the Equation of Continuity Q = A · V in which Q represents blood flow volume, A the sectional area of a vessel, and V blood flow velocity as well as Bernoulli’s Principle 1/2 V2 + P/ρ = constant where V represents blood flow velocity, P static blood pressure and ρ blood density. The Equation of Continuity states that a decrease in flow volume occurs simultaneously with a decrease in the flow velocity and/or sectional area, and vice versa. Bernoulli’s Principle states that a decrease in the velocity of a fluid occurs simultaneously with an increase in static pressure, and vice versa. Results: Hyperpermeability of the choriocapillaris, as visualized on fluorescein angiography and indocyanine green angiography (ICGA), causes a fluid exudation and, therefore, a decrease in the blood flow volume Q which elicits a simultaneous decrease in the blood flow velocity V clinically observable in filling delay into the choriocapillaris on ICGA. An increase in the static blood pressure P will simultaneously occur in venules in accord with Bernoulli’s Principle. Conclusions: A decrease in the blood flow velocity in the choriocapillaris due to its hyperpermeability will hydrodynamically elicit an increase in the blood pressure in venules. This blood pressure rise may expand Sattler and Haller veins, forming pachyveins. The primary lesion of PSD can be in pigment epithelium and choriocapillaris.
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Affiliation(s)
- Okihiro Nishi
- Jinshikai Medical Foundation, Nishi Eye Hospital, 4-14-26 Nakamichi, Higashinari-ku, Osaka 537-0025, Japan
- Correspondence: ; Tel.: +81-6-6981-1132; Fax: +81-6-6981-5630
| | - Tsutomu Yasukawa
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya 464-0083, Japan
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28
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Matsumoto H, Mukai R, Saito K, Hoshino J, Kishi S, Akiyama H. Vortex vein congestion in the monkey eye: A possible animal model of pachychoroid. PLoS One 2022; 17:e0274137. [PMID: 36048858 PMCID: PMC9436071 DOI: 10.1371/journal.pone.0274137] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To create vortex vein congestion in the monkey eye as a possible pachychoroid model. Methods We ligated superotemporal and inferotemporal vortex veins at the surface of the sclera in monkey eyes. Optical coherence tomography (OCT) and indocyanine green angiography (ICGA) were performed before and 2, 7, and 28 days after the vortex vein ligations to investigate changes in vortex vein morphology and alterations in choroidal blood flow. Results Before the vortex vein ligations, en face OCT and ICGA images showed well organized vortex veins as well as horizontal and vertical watershed zones. Two days after the vortex vein ligations, dilatation of the superotemporal and inferotemporal vortex veins as well as intervortex venous anastomoses were seen on en face OCT and ICGA images. B-mode OCT images showed choroidal thickening associated with dilatation of the outer choroidal vessels. Moreover, video ICGA revealed choriocapillaris filling delay and pulsatile flow in the dilated vortex veins. At 7 and 28 days after we ligated the vortex veins, these findings were reduced, except for the intervortex venous anastomoses. Conclusions We created a monkey model of vortex vein congestion by ligating two vortex veins. This animal model demonstrated pachychoroid-related findings, indicating that vortex vein congestion is involved in the pathogenesis of pachychoroid. However, remodeling of the choroidal drainage route via intervortex venous anastomosis appeared to compensate for the vortex vein congestion created in this model.
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Affiliation(s)
- Hidetaka Matsumoto
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Japan
- * E-mail:
| | - Ryo Mukai
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kazuma Saito
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Junki Hoshino
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Shoji Kishi
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hideo Akiyama
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Japan
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29
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Harada N, Nagai N, Mushiga Y, Ozawa Y. Choriocapillaris Flow Imbalance in Fellow Eyes in Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2022; 63:13. [PMID: 35943731 PMCID: PMC9379328 DOI: 10.1167/iovs.63.9.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to identify early changes in choriocapillaris flow in patients with age-related macular degeneration (AMD) with no history of macular neovascularization (MNV). Methods Clinical records of fellow eyes of patients with unilateral neovascular AMD without fundus findings and control eyes of otherwise healthy individuals, except for mild cataract, diagnosed at St. Luke's International Hospital from April 2020 to March 2021, were retrospectively analyzed. Optical coherence tomography (OCT) angiography images of the choriocapillaris slab were binarized using the Phansalkar local thresholding methods to evaluate the choriocapillaris flow area (CCFA) and its coefficient of variation (CV). Results The data of 24 AMD fellow eyes (17 for men, 71.7 ± 1.9 years old) and 21 control eyes (11 for men, 69.1 ± 2.0 years old) were analyzed. The mean CCFA ratio was lower in the AMD fellow eyes (58.6 ± 1.2%) than in the control eyes (62.4 ± 1.3%, P = 0.032), and the mean CV of CCFA ratio was greater in the AMD fellow eyes (0.174 ± 0.007) than in the control eyes (0.154 ± 0.007, P = 0.032). Eyes with CCFA ratio <60% and CV of CCFA ratio ≥0.154 had a 4.371-fold higher risk of being AMD fellow eyes (95% confidence interval = 1.029–18.56, P = 0.046). Differences in CV of CCFA ratio between AMD fellow eyes and control eyes were particularly clear in eyes with thick choroids (mean CV of CCFA in control versus AMD fellow eyes with central choroidal thickness ≥220 µm: 0.144 ± 0.005 vs. 0.173 ± 0.007, P = 0.009**). Conclusions Neovascular AMD fellow eyes without MNV had reduced, heterogeneous, and imbalanced choriocapillaris flow, which may constitute early changes in neovascular AMD, although further studies are required.
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Affiliation(s)
- Narumi Harada
- Department of Ophthalmology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Norihiro Nagai
- Department of Ophthalmology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan.,St. Luke's International University, Chuo-ku, Tokyo, Japan.,Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Yasuaki Mushiga
- Department of Ophthalmology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan.,St. Luke's International University, Chuo-ku, Tokyo, Japan
| | - Yoko Ozawa
- Department of Ophthalmology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan.,St. Luke's International University, Chuo-ku, Tokyo, Japan.,Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.,https://orcid.org/0000-0003-4797-5705
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30
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Nishi O, Yasukawa T. Comment on "Clinical Factors Related to Loculation of Fluid in Central Serous Chorioretinopathy". Am J Ophthalmol 2022; 241:293-294. [PMID: 35750216 DOI: 10.1016/j.ajo.2022.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 11/01/2022]
Affiliation(s)
| | - Tsutomu Yasukawa
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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31
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Kishi S, Matsumoto H. A new insight into pachychoroid diseases: Remodeling of choroidal vasculature. Graefes Arch Clin Exp Ophthalmol 2022; 260:3405-3417. [PMID: 35575932 PMCID: PMC9581833 DOI: 10.1007/s00417-022-05687-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/17/2022] [Accepted: 04/22/2022] [Indexed: 02/07/2023] Open
Abstract
Purpose Pachychoroid spectrum diseases are regarded as being different manifestations of a common pathogenic process. We suggest that pachychoroid diseases are consequences of chronic vortex vein stasis. Methods We describe how we came to this conclusion based on our own recent reports as well as a search of the related literature. Results Central serous chorioretinopathy (CSC) is the first stage of pachychoroid spectrum diseases. CSC is caused by congestion of choroidal veins, which are branches of the vortex veins. The venous outflow tract of the choroid is divided into four quadrants, based on horizontal and vertical watershed zones, with one or two vortex veins in each quadrant being independently responsible for venous outflow. In acute CSC, vortex vein stasis frequently causes asymmetric dilatation of the vortex veins in the horizontal watershed. The area of geographic filling delay in the choriocapillaris coincides with the area of this asymmetrically dilated vortex veins. With chronic stasis of the vortex veins, venous anastomosis occurs in the watershed zone as a means of compensating for the stasis, and the choriocapillaris becomes occluded in the area of filling delay. The anastomotic vessels dilate, becoming often hyperpermeable, and are then recognizable as pachyvessels. With the development of choriocapillaris ischemia, choroidal neovascularization (CNV) occurs at the site of pachyvessels. This is termed pachychoroid neovasculopathy (PNV). Polypoidal choroidal vasculopathy is regarded as a variant of PNV. Conclusions Intervortex venous anastomosis is among the key factors underlying the development of pachychoroid diseases. Remodeling of the venous drainage route though the anastomosis across the watershed zones is apparently a common response to chronic vortex vein stasis. ![]()
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Affiliation(s)
- Shoji Kishi
- Maebashi Central Eye Clinic, 2-54-5 Shimokoide, Maebashi, Gunma, 371-0031, Japan.
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15, showa, Maebashi, Gunma, 371-8511, Japan.
| | - Hidetaka Matsumoto
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15, showa, Maebashi, Gunma, 371-8511, Japan
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32
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Kanda P, Gupta A, Gottlieb C, Karanjia R, Coupland SG, Bal MS. Pathophysiology of central serous chorioretinopathy: a literature review with quality assessment. Eye (Lond) 2022; 36:941-962. [PMID: 34654892 PMCID: PMC9046392 DOI: 10.1038/s41433-021-01808-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 09/15/2021] [Accepted: 10/01/2021] [Indexed: 01/31/2023] Open
Abstract
The pathogenesis of central serous chorioretinopathy (CSCR), a pachychoroid disease, is poorly understood. While choroid hyperpermeability and retinal pigment epithelium dysfunction are cornerstones for developing CSCR, the mechanisms at the retinal, vascular, retinal pigment epithelium, and cellular level continue to be an enigma. A few preclinical studies and the development of small-sized, poorly controlled clinical trials have resulted in limited insight into the disease mechanism. Effective treatments for CSCR are still lacking as current trials have produced inconsistent results for functional and structural gains. Thus, critically evaluating the literature to explore disease mechanisms and provide an up-to-date understanding of pathophysiology can provide valuable information and avenues to new treatments. In this study, a comprehensive summary of the mechanistic insight into CSCR is presented while highlighting the shortcomings of current literature. The mechanism was divided into seven sub-categories including mechanical obstruction, inflammation, oxidative stress, paracrine factors, autonomic dysfunction, mineralocorticoid receptors activation, and medications. We implemented validated tools like the JBI and CAMARADES to objectively analyze the quality of both clinical and preclinical studies, respectively. Overall, our analysis of the literature showed that no single mechanism was populated with a large number of sufficiently sized and good-quality studies. However, compiling these studies gave hints not only to CSCR pathogenesis but also pachychoroid disease in general while providing suggestions for future exploration.
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Affiliation(s)
- Pushpinder Kanda
- grid.28046.380000 0001 2182 2255Department of Ophthalmology, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada ,grid.412687.e0000 0000 9606 5108University of Ottawa Eye Institute, The Ottawa Hospital, Ottawa, ON Canada
| | - Arnav Gupta
- grid.28046.380000 0001 2182 2255Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Chloe Gottlieb
- grid.28046.380000 0001 2182 2255Department of Ophthalmology, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada ,grid.412687.e0000 0000 9606 5108University of Ottawa Eye Institute, The Ottawa Hospital, Ottawa, ON Canada ,grid.412687.e0000 0000 9606 5108Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Rustum Karanjia
- grid.28046.380000 0001 2182 2255Department of Ophthalmology, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada ,grid.412687.e0000 0000 9606 5108University of Ottawa Eye Institute, The Ottawa Hospital, Ottawa, ON Canada ,grid.412687.e0000 0000 9606 5108Ottawa Hospital Research Institute, Ottawa, ON Canada ,grid.280881.b0000 0001 0097 5623Doheny Eye Institute, Los Angeles, CA 90033 USA ,grid.19006.3e0000 0000 9632 6718Doheny Eye Centers UCLA, Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA 91105 USA
| | - Stuart G. Coupland
- grid.28046.380000 0001 2182 2255Department of Ophthalmology, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada ,grid.412687.e0000 0000 9606 5108University of Ottawa Eye Institute, The Ottawa Hospital, Ottawa, ON Canada ,grid.28046.380000 0001 2182 2255Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Manpartap Singh Bal
- grid.511274.4Queen’s University School of Medicine, Department of Ophthalmology, Kingston Health Science Centre, Kingston, ON Canada
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33
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Matsumoto H, Hoshino J, Mukai R, Nakamura K, Kishi S, Akiyama H. Clinical characteristics and pachychoroid incidence in Japanese patients with neovascular age-related macular degeneration. Sci Rep 2022; 12:4492. [PMID: 35296769 PMCID: PMC8927155 DOI: 10.1038/s41598-022-08666-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/11/2022] [Indexed: 11/09/2022] Open
Abstract
The phenotypes of neovascular age-related macular degeneration (nAMD) are recognized as differing between Caucasian and Asian patients. Pachychoroid is thought to be more prevalent in Asians than in Caucasians, and may be involved in the development of nAMD in Asian patients. Therefore, we investigated the clinical characteristics and pachychoroid incidence in Japanese patients with nAMD. We retrospectively analyzed 385 eyes of 370 consecutive Japanese patients with treatment naïve nAMD. According to the nAMD nomenclature, type 1 macular neovascularization (MNV) was observed in 132 eyes (34.3%), polypoidal choroidal vasculopathy (PCV) in 137 (35.6%), mixed type 1 and type 2 MNV in 32 (8.3%), type 2 MNV in 43 (11.2%), and type 3 MNV in 41 (10.6%). Pachychoroid was seen in 58.3% of type 1 MNV, 75.2% of PCV, 34.4% of mixed type 1 and type 2 MNV, 14.0% of type 2 MNV, and 0% of type 3 MNV. Compared to nAMD patients without pachychoroid (188 eyes), those who had nAMD with pachychoroid (197 eyes) were significantly younger, had a higher proportion of males, greater central choroidal thickness, and a higher frequency of macular vortex vein anastomoses (all P < 0.001). Furthermore, drusen subtypes differed significantly between the two groups (P < 0.001). These results suggest that most Japanese nAMD patients might have type 1 MNV or PCV. Moreover, in approximately half of patients, nAMD might be associated with pachychoroid, and choroidal congestion may be involved in the development of MNV in these cases.
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Affiliation(s)
- Hidetaka Matsumoto
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Junki Hoshino
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Ryo Mukai
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Kosuke Nakamura
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Shoji Kishi
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hideo Akiyama
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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34
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Hwang BE, Kwak JH, Kim JY, Kim RY, Kim M, Park YG, Park YH. Quantitative analysis of choroidal blood flow parameters in optical coherence tomography and angiography in central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2022; 260:2111-2120. [PMID: 35201403 DOI: 10.1007/s00417-022-05588-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the choriocapillaris (CC) flow in central serous chorioretinopathy (CSC) and determine the relationship between CC flow void with the choroidal thickness (CT) and choroidal vascularity index (CVI). METHODS Retrospective analysis of 20 patients with CSC (40 eyes, including unaffected fellow eyes) and 20 age- and sex-matched controls. After compensation with optical coherence tomography (OCT) en-face structural image, the CC flow void (%) was measured using the phansalkar threshold with a window radius of 3 and 15 pixels. The mean CC flow voids of acute CSC, recovered-acute CSC, unaffected fellow, and control eyes were compared by matched data analysis. A regression analysis was performed on the choroidal parameters (CT and CVI) and CC flow voids. RESULTS The CC flow void had an increasing tendency in the following order: control, fellow, recovered-acute CSC, and acute CSC eyes. Acute/recovered comparison showed a significant P value (0.008) in the foveal lesion. Recovered/fellow and fellow/control presented significant P values regardless of location to fovea (all <0.05). There were significant positive correlations between CT and CC flow void (P < 0.05) in the acute CSC, recovered-acute CSC eyes. CONCLUSION The CC flow on OCT angiography decreased in acute CSC eyes, especially in the foveal lesion, with a published compensation method. The findings suggest that unmodulated choroidal blood flow contributed to partially reversible diminished CC flow.
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Affiliation(s)
- Bo-Een Hwang
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
- Catholic Institute for Visual Science, The Catholic University of Korea School of Medicine, Seoul, Republic of Korea
| | - Jae-Hyuck Kwak
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
- Catholic Institute for Visual Science, The Catholic University of Korea School of Medicine, Seoul, Republic of Korea
| | - Joo-Young Kim
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
- Catholic Institute for Visual Science, The Catholic University of Korea School of Medicine, Seoul, Republic of Korea
| | - Rae-Young Kim
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
- Catholic Institute for Visual Science, The Catholic University of Korea School of Medicine, Seoul, Republic of Korea
| | - Mirinae Kim
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
- Catholic Institute for Visual Science, The Catholic University of Korea School of Medicine, Seoul, Republic of Korea
| | - Young-Geun Park
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
- Catholic Institute for Visual Science, The Catholic University of Korea School of Medicine, Seoul, Republic of Korea
| | - Young-Hoon Park
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
- Catholic Institute for Visual Science, The Catholic University of Korea School of Medicine, Seoul, Republic of Korea.
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35
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Bacci T, Oh DJ, Singer M, Sadda S, Freund KB. Ultra-Widefield Indocyanine Green Angiography Reveals Patterns of Choroidal Venous Insufficiency Influencing Pachychoroid Disease. Invest Ophthalmol Vis Sci 2022; 63:17. [PMID: 35019945 PMCID: PMC8762674 DOI: 10.1167/iovs.63.1.17] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To compare patterns of choroidal venous drainage in eyes with pachychoroid disease to those of healthy subjects using ultra-widefield indocyanine green angiography (UWF ICGA). Methods Patients with pachychoroid disease and healthy controls were recruited at two referral centers. UWF ICGA images were used to evaluate the proportion of the postequatorial fundus drained by major vortex vein systems in each quadrant and to study the incidence and topography of choroidal vascular hyperpermeability (CVH) and intervortex venous anastomoses. Widefield swept-source optical coherence tomography (SS-OCT) was used to evaluate choroidal thickness at the posterior pole in eyes with pachychoroid disease. Results Fifty-two pachychoroid eyes and 26 healthy eyes were evaluated. Eyes with pachychoroid disease showed a significant within-subject variance in the proportion of the postequatorial fundus drained by each vortex vein system (range, 4.1%–48.1%; P < 0.0001) that was not seen in controls (range, 17.3%–31.7%; P = 0.11). CVH was present in all pachychoroid disease eyes and three of 26 controls. Intervortex venous anastomoses were present in 46 of 52 pachychoroid disease eyes and nine of 26 control eyes. Vortex vein systems with large drainage areas showed greater density of CVH spots. SS-OCT demonstrated asymmetric choroidal drainage in the macula of 59% of pachychoroid eyes. CVH and intervortex venous anastomoses were more prominent in areas showing maximal choroidal thickness. Conclusions In eyes with pachychoroid disease, imbalanced choroidal venous drainage with congestion of specific vortex vein systems may contribute to a state of choroidal venous insufficiency characterized by regional choroidal thickening, CVH and remodeling of venous drainage routes.
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Affiliation(s)
- Tommaso Bacci
- Vitreous Retina Macula Consultants of New York, New York, New York, United States.,Department of Ophthalmology, New York University Grossman School of Medicine, New York, New York, United States.,Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena University Hospital, Siena, Italy
| | - Daniel J Oh
- Vitreous Retina Macula Consultants of New York, New York, New York, United States.,Department of Ophthalmology, New York University Grossman School of Medicine, New York, New York, United States.,LuEsther T. Mertz Retina Research Laboratory, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States.,Columbia University Irving Medical Center, Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, New York, New York, United States
| | - Michael Singer
- Medical Center of Ophthalmology, University of Texas Health Science Center, San Antonio, Texas, United States
| | - SriniVas Sadda
- Doheny Eye Institute, Los Angeles, California, United States.,Ophthalmology, David Geffen School of Medicine, Los Angeles, California, United States
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, United States.,Department of Ophthalmology, New York University Grossman School of Medicine, New York, New York, United States.,LuEsther T. Mertz Retina Research Laboratory, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States.,Columbia University Irving Medical Center, Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, New York, New York, United States
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Terao N, Imanaga N, Wakugawa S, Sawaguchi S, Tamashiro T, Yamauchi Y, Koizumi H. Short Axial Length Is Related to Asymmetric Vortex Veins in Central Serous Chorioretinopathy. OPHTHALMOLOGY SCIENCE 2021; 1:100071. [PMID: 36246946 PMCID: PMC9560636 DOI: 10.1016/j.xops.2021.100071] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/16/2021] [Accepted: 10/19/2021] [Indexed: 02/05/2023]
Abstract
Purpose To investigate the clinical and morphologic factors related to asymmetric dilated vortex veins in central serous chorioretinopathy (CSC). Design Retrospective, comparative study. Participants One hundred fifty-eight eyes of 158 patients with CSC. Methods All patients with CSC underwent ophthalmic examination and multimodal imaging, including measurements of axial length (AL), fluorescein angiography, indocyanine green angiography, swept-source OCT, and anterior segment OCT. Using en face OCT images at the level of the outer choroid, the eyes were divided into 2 groups: eyes with symmetric vortex veins (symmetry group) and those with asymmetric vortex veins (asymmetry group). Main Outcome Measures Clinical and morphologic factors related to asymmetric vortex veins in CSC. Results Of the 158 eyes, 120 eyes (75.9%) were classified into the asymmetry group and 38 eyes (24.1%) were classified into the symmetry group. The asymmetry group showed significantly greater spherical equivalent (–0.32 ± 1.78 diopters [D] vs. –1.35 ± 2.64 D; P = 0.033), shorter AL (23.52 ± 0.86 mm vs. 24.10 ± 1.06 mm; P = 0.005), and greater subfoveal choroidal thickness (414.6 ± 105.3 μm vs. 360.4 ± 91.8 μm; P = 0.005) than the symmetry group. No significant differences existed between the 2 groups regarding age, sex, or all scleral thicknesses at the superior, temporal, inferior, and nasal points. In the multivariate analyses, shorter AL (odds ratio, 0.56; 95% confidence interval, 0.36–0.88; P = 0.011) was found to be significantly associated with the presence of asymmetric vortex veins. Conclusions The asymmetric dilated vortex vein is a common finding in patients with CSC. Our results suggest that certain biometric factors, such as short AL, may be associated with asymmetric dilated vortex veins developing in patients with CSC.
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Affiliation(s)
| | | | | | | | | | | | - Hideki Koizumi
- Correspondence: Hideki Koizumi, MD, PhD, Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan.
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37
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Shinojima A, Lee D, Tsubota K, Negishi K, Kurihara T. Retinal Diseases Regulated by Hypoxia-Basic and Clinical Perspectives: A Comprehensive Review. J Clin Med 2021; 10:jcm10235496. [PMID: 34884197 PMCID: PMC8658588 DOI: 10.3390/jcm10235496] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/08/2021] [Accepted: 11/19/2021] [Indexed: 11/16/2022] Open
Abstract
In recent years, the number of patients with age-related macular degeneration (AMD) is increasing worldwide along with increased life expectancy. Currently, the standard treatment for wet-AMD is intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs. The upstream of VEGF is hypoxia-inducible factor (HIF), a master regulator of hypoxia-responsive genes responsive to acute and chronic hypoxia. HIF activation induces various pathological pro-angiogenic gene expressions including VEGF under retinal hypoxia, ultimately leading to the development of ocular ischemic neovascular diseases. In this regard, HIF is considered as a promising therapeutic target in ocular ischemic diseases. In clinical ophthalmology, abnormal hypofluorescent areas have been detected in the late-phase of indocyanine green angiography, which are thought to be lipid deposits at the level of Bruch’s membrane to choriocapillaris in vitreoretinal diseases. These deposits may interfere with the oxygen and nutrients that should be supplied to the retinal pigment epithelium, and that HIF/VEGF is highly suspected to be expressed in the hypoxic retinal pigment epithelium, leading to neovascularization. In this review, we comprehensively summarize pathophysiology of AMD-related ocular diseases with the HIF/VEGF pathway from basic and clinic researches with recent findings.
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Affiliation(s)
- Ari Shinojima
- Laboratory of Photobiology, Keio University School of Medicine, Tokyo 160-8582, Japan; (A.S.); (D.L.)
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.T.); (K.N.)
| | - Deokho Lee
- Laboratory of Photobiology, Keio University School of Medicine, Tokyo 160-8582, Japan; (A.S.); (D.L.)
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.T.); (K.N.)
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.T.); (K.N.)
- Tsubota Laboratory, Inc., Tokyo 160-0016, Japan
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.T.); (K.N.)
| | - Toshihide Kurihara
- Laboratory of Photobiology, Keio University School of Medicine, Tokyo 160-8582, Japan; (A.S.); (D.L.)
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (K.T.); (K.N.)
- Correspondence: ; Tel.: +81-3-5313-4132; Fax: +81-3-5363-3274
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38
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Choroidal alterations during the clinical course of commotio retinae. Graefes Arch Clin Exp Ophthalmol 2021; 260:65-71. [PMID: 34379185 DOI: 10.1007/s00417-021-05316-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/24/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To analyse the alterations in the choroidal structure of eyes with commotio retinae due to blunt-force trauma. METHODS This retrospective study included 51 eyes of 50 patients who underwent swept-source optical coherence tomography (SS-OCT) during their initial visit and throughout their clinical course between March 2013 and February 2020. MAIN OUTCOMES AND MEASURES This study focused on four choroidal measures: comparison of central choroidal thickness (CCT) between the injured and contralateral eyes immediately after injury, changes in the CCT, ratio of choroidal luminal and stromal properties in the injured eye during the clinical course and change in the suprachoroidal structure of the injured eye. RESULTS In 44 eyes, the CCT was successfully compared between the injured and contralateral eyes. In 30 of these eyes (70%), the CCT in the injured eye was significantly thinner than that in the contralateral eye (P < 0.01). In 33 eyes, the clinical course of the injured eyes was followed. The CCT was increased and decreased by >30 μm in 11 (33%) and 6 eyes (18%), respectively, and remained the same in 16 eyes (49%). The ratio of luminal and stromal areas in the choroid had significantly increased from 1.72 ± 0.54 at the initial visit to 1.87 ± 0.55 at the last visit (P < 0.001). In four eyes, a hemispherical dark space was observed beneath the sclerochoroidal interphase at the initial visit. CONCLUSION The choroidal structure and its luminal and stromal properties are dynamically altered during the clinical course of commotio retinae.
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39
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Matsumoto H, Hoshino J, Mukai R, Nakamura K, Kishi S, Akiyama H. Chronic choriocapillaris ischemia in dilated vortex vein region in pachychoroid neovasculopathy. Sci Rep 2021; 11:16274. [PMID: 34381134 PMCID: PMC8357816 DOI: 10.1038/s41598-021-95904-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/02/2021] [Indexed: 11/09/2022] Open
Abstract
We evaluated choroidal congestion using multimodal imaging in pachychoroid neovasculopathy (PNV). In a retrospective case series of 100 eyes of 99 treatment-naïve PNV patients, their clinical records were reviewed and the corresponding multimodal imaging studies were analyzed. We assessed areas of choriocapillaris filling delay which overlapped with dilated outer choroidal vessels, choroidal neovascularization (CNV), and retinal pigment epithelium (RPE) atrophy. The study subjects were 78 men (78.8%) and 21 women (21.2%). The mean patient age was 67.5 ± 10.5 years. On indocyanine green angiography, all eyes showed choriocapillaris filling delay in the early phase. Dilated outer choroidal vessels were demonstrated in all eyes by en face optical coherence tomography. The areas of choriocapillaris filling delay overlapped extensively with that of dilated outer choroidal vessels. All eyes showed CNV localized within the sites of choriocapillaris filling delay. RPE atrophy was noted in 71 eyes (71.0%), and 68 of these (95.8%) had RPE atrophy within the areas showing choriocapillaris filling delay. These findings indicate that chronic choriocapillaris ischemia secondary to vortex vein congestion may lead to CNV development as well as RPE atrophy in eyes with PNV.
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Affiliation(s)
- Hidetaka Matsumoto
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Junki Hoshino
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Ryo Mukai
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Kosuke Nakamura
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Shoji Kishi
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hideo Akiyama
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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40
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Multimodal Imaging in Pachychoroid Spectrum. Surv Ophthalmol 2021; 67:579-590. [PMID: 34331955 DOI: 10.1016/j.survophthal.2021.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 11/21/2022]
Abstract
Diagnostic investigation on pachychoroid spectrum disease (PSD) has been growing along with the rapid advancement of imaging technology. In optical coherence tomography (OCT)-based studies, choroidal thickness profile, luminal and stromal choroidal ratio, and abnormalities in the neurosensory retina have demonstrated various patterns in different clinical entities related to PSD. The emerging role of OCT angiography (OCTA) has been expanded to involve the quantitative analysis of the OCTA parameters in different clinical entities of PSD and to evaluate the choriocapillaris signal void and vessel density as indicators of choriocapillaris ischemia. OCTA has broadened our knowledge in characterization and assessment of both active and quiescent choroidal neovascularization and its association with treatment response. Recent studies using indocyanine green angiography (ICG) have focused on the evaluation of choroidal vascular hyperpermeability and its relationship with other pachychoroid related features. Ultrawidefield ICG enables observation and characterization of peripheral choroidal pathologies and their associations with macular abnormalities. Multicolor imaging is an emerging modality with the capability to demonstrate early abnormalities in PSD. We summarize all investigations reflecting the new insights into the application of multimodal imaging for PSD and focuses on novel findings observed in different clinical entities with each imaging modality.
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41
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Matsumoto H, Hoshino J, Mukai R, Nakamura K, Kishi S, Akiyama H. Pulsation of anastomotic vortex veins in pachychoroid spectrum diseases. Sci Rep 2021; 11:14942. [PMID: 34294774 PMCID: PMC8298457 DOI: 10.1038/s41598-021-94412-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/12/2021] [Indexed: 11/21/2022] Open
Abstract
Accumulating evidence points to pachychoroid possibly being caused by vortex vein congestion which results in remodeling of choroidal drainage routes via intervortex vein anastomosis. This hypothesis prompted us to investigate vortex vein hemodynamics by studying videos of indocyanine green angiography (ICGA) in a retrospective case series of 295 eyes with pachychoroid spectrum diseases. In the early phase of the video-ICGA, pulsatile vortex venous flow was observed in 76 eyes (25.8%) at the vortex veins connected with anastomosis between superior and inferior vortex veins. The patients with pulsatile vortex venous flow were significantly older than those without pulsatile vortex venous flow (67.8 ± 13.2 vs. 63.9 ± 14.5 years, P < 0.05). Pulsatile vortex venous flow was 1.84 times more common in the inferior quadrants than in the superior quadrants. Interestingly, 14 of 76 eyes (18.4%) with pulsatile vortex venous flow showed retrograde pulsatile blood flow in the vortex veins. This retrograde pulsatile blood flow was 2.50 times more common in the inferior than in the superior quadrants. These findings indicate altered vortex vein hemodynamics due to vortex vein congestion in pachychoroid spectrum diseases.
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Affiliation(s)
- Hidetaka Matsumoto
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Junki Hoshino
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Ryo Mukai
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Kosuke Nakamura
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Shoji Kishi
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hideo Akiyama
- Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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42
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Lejoyeux R, Benillouche J, Ong J, Errera MH, Rossi EA, Singh SR, Dansingani KK, da Silva S, Sinha D, Sahel JA, Freund KB, Sadda SR, Lutty GA, Chhablani J. Choriocapillaris: Fundamentals and advancements. Prog Retin Eye Res 2021; 87:100997. [PMID: 34293477 DOI: 10.1016/j.preteyeres.2021.100997] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/02/2021] [Accepted: 07/13/2021] [Indexed: 12/19/2022]
Abstract
The choriocapillaris is the innermost structure of the choroid that directly nourishes the retinal pigment epithelium and photoreceptors. This article provides an overview of its hemovasculogenesis development to achieve its final architecture as a lobular vasculature, and also summarizes the current histological and molecular knowledge about choriocapillaris and its dysfunction. After describing the existing state-of-the-art tools to image the choriocapillaris, we report the findings in the choriocapillaris encountered in the most frequent retinochoroidal diseases including vascular diseases, inflammatory diseases, myopia, pachychoroid disease spectrum disorders, and glaucoma. The final section focuses on the development of imaging technology to optimize visualization of the choriocapillaris as well as current treatments of retinochoroidal disorders that specifically target the choriocapillaris. We conclude the article with pertinent unanswered questions and future directions in research for the choriocapillaris.
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Affiliation(s)
| | | | - Joshua Ong
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Marie-Hélène Errera
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Ethan A Rossi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA 15213, USA
| | - Sumit R Singh
- Jacobs Retina Center, Shiley Eye Institute, University of California San Diego, San Diego, CA, USA
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Susana da Silva
- Department of Ophthalmology and Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Debasish Sinha
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Department of Cell Biology and Center for Biologic Imaging, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - José-Alain Sahel
- Rothschild Foundation, 75019, Paris, France; Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France; CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, Paris, France
| | - K Bailey Freund
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Vitreous Retina Macula Consultants of New York, New York, NY, USA; Department of Ophthalmology, New York University of Medicine, New York, NY, USA; Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, 90033, USA; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gerard A Lutty
- Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD, 21287, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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43
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Brinks J, van Dijk EHC, Klaassen I, Schlingemann RO, Kielbasa SM, Emri E, Quax PHA, Bergen AA, Meijer OC, Boon CJF. Exploring the choroidal vascular labyrinth and its molecular and structural roles in health and disease. Prog Retin Eye Res 2021; 87:100994. [PMID: 34280556 DOI: 10.1016/j.preteyeres.2021.100994] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/04/2021] [Accepted: 07/07/2021] [Indexed: 12/14/2022]
Abstract
The choroid is a key player in maintaining ocular homeostasis and plays a role in a variety of chorioretinal diseases, many of which are poorly understood. Recent advances in the field of single-cell RNA sequencing have yielded valuable insights into the properties of choroidal endothelial cells (CECs). Here, we review the role of the choroid in various physiological and pathophysiological mechanisms, focusing on the role of CECs. We also discuss new insights regarding the phenotypic properties of CECs, CEC subpopulations, and the value of measuring transcriptomics in primary CEC cultures derived from post-mortem eyes. In addition, we discuss key phenotypic, structural, and functional differences that distinguish CECs from other endothelial cells such as retinal vascular endothelial cells. Understanding the specific clinical and molecular properties of the choroid will shed new light on the pathogenesis of the broad clinical range of chorioretinal diseases such as age-related macular degeneration, central serous chorioretinopathy and other diseases within the pachychoroid spectrum, uveitis, and diabetic choroidopathy. Although our knowledge is still relatively limited with respect to the clinical features and molecular pathways that underlie these chorioretinal diseases, we summarise new approaches and discuss future directions for gaining new insights into these sight-threatening diseases and highlight new therapeutic strategies such as pluripotent stem cell‒based technologies and gene therapy.
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Affiliation(s)
- J Brinks
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - E H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - I Klaassen
- Ocular Angiogenesis Group, Departments of Ophthalmology and Medical Biology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - R O Schlingemann
- Ocular Angiogenesis Group, Departments of Ophthalmology and Medical Biology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - S M Kielbasa
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands
| | - E Emri
- Department of Clinical Genetics, Section of Ophthalmogenetics, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - P H A Quax
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, the Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - A A Bergen
- Department of Clinical Genetics, Section of Ophthalmogenetics, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - O C Meijer
- Department of Medicine, Division of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, the Netherlands
| | - C J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
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44
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Spaide RF, Gemmy Cheung CM, Matsumoto H, Kishi S, Boon CJF, van Dijk EHC, Mauget-Faysse M, Behar-Cohen F, Hartnett ME, Sivaprasad S, Iida T, Brown DM, Chhablani J, Maloca PM. Venous overload choroidopathy: A hypothetical framework for central serous chorioretinopathy and allied disorders. Prog Retin Eye Res 2021; 86:100973. [PMID: 34029721 DOI: 10.1016/j.preteyeres.2021.100973] [Citation(s) in RCA: 145] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 12/19/2022]
Abstract
In central serous chorioretinopathy (CSC), the macula is detached because of fluid leakage at the level of the retinal pigment epithelium. The fluid appears to originate from choroidal vascular hyperpermeability, but the etiology for the fluid is controversial. The choroidal vascular findings as elucidated by recent optical coherence tomography (OCT) and wide-field indocyanine green (ICG) angiographic evaluation show eyes with CSC have many of the same venous patterns that are found in eyes following occlusion of the vortex veins or carotid cavernous sinus fistulas (CCSF). The eyes show delayed choroidal filling, dilated veins, intervortex venous anastomoses, and choroidal vascular hyperpermeability. While patients with occlusion of the vortex veins or CCSF have extraocular abnormalities accounting for the venous outflow problems, eyes with CSC appear to have venous outflow abnormalities as an intrinsic phenomenon. Control of venous outflow from the eye involves a Starling resistor effect, which appears to be abnormal in CSC. Similar choroidal vascular abnormalities have been found in peripapillary pachychoroid syndrome. However, peripapillary pachychoroid syndrome has intervortex venous anastomoses located in the peripapillary region while in CSC these are seen to be located in the macular region. Spaceflight associated neuro-ocular syndrome appears to share many of the pathophysiologic problems of abnormal venous outflow from the choroid along with a host of associated abnormalities. These diseases vary according to their underlying etiologies but are linked by the venous decompensation in the choroid that leads to significant vision loss. Choroidal venous overload provides a unifying concept and theory for an improved understanding of the pathophysiology and classification of a group of diseases to a greater extent than previous proposals.
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Affiliation(s)
- Richard F Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, NY, USA.
| | | | - Hidetaka Matsumoto
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Japan.
| | | | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands.
| | | | | | | | | | | | | | - Jay Chhablani
- University of Pittsburgh, UPMC Eye Center, Pittsburgh, PA, USA.
| | - Peter M Maloca
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland.
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45
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Funatsu R, Terasaki H, Shiihara H, Kawano S, Hirokawa M, Tanabe Y, Fujiwara T, Mitamura Y, Sakamoto T, Sonoda S. Quantitative evaluations of vortex vein ampullae by adjusted 3D reverse projection model of ultra-widefield fundus images. Sci Rep 2021; 11:8916. [PMID: 33903616 PMCID: PMC8076294 DOI: 10.1038/s41598-021-88265-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/05/2021] [Indexed: 11/19/2022] Open
Abstract
The purpose of this study was to determine the number and location of vortex vein ampullae (VVA) in normal eyes. This was an observational retrospective study. Montage images of one on-axis and two off-axis ultra-widefield images of 74 healthy eyes were enhanced, and reverse projected onto a 3D model eye. The number and distance between the optic disc to each VVA in the four sectors were compared. The significance of correlations between these values and age, sex, visual acuity, refractive error, and axial length was determined. The mean number of VVA was 8.10/eye with 1.84, 2.12, 2.19 and 1.95 in upper lateral, lower lateral, upper nasal, and lower nasal sectors, respectively. The mean number of VVA/eye was significantly greater in men at 8.43 than women at 7.76 (P = 0.025). The mean distance between the optic disc and VVA was 14.15 mm, and it was 14.04, 15.55, 13.29 and 13.66 mm in the upper lateral, lower lateral, upper nasal and lower nasal sectors, respectively (all P < 0.05). The number and location of VVA can be obtained non-invasively, and the number was significantly higher in men than women. This technique can be used to determine whether these values are altered in a retinochoroidal disease.
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Affiliation(s)
- Ryoh Funatsu
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.,Japan-Clinical Retina Study (J-CREST) Group, Kagoshima, Japan
| | - Hiroto Terasaki
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.,Japan-Clinical Retina Study (J-CREST) Group, Kagoshima, Japan
| | - Hideki Shiihara
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.,Japan-Clinical Retina Study (J-CREST) Group, Kagoshima, Japan
| | - Sumihiro Kawano
- Department of Ophthalmology, Kurashiki Chuo Hospital, Kurashiki, Japan
| | | | | | | | - Yoshinori Mitamura
- Japan-Clinical Retina Study (J-CREST) Group, Kagoshima, Japan.,Department of Ophthalmology, Tokushima University Graduate School, Tokushima, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan. .,Japan-Clinical Retina Study (J-CREST) Group, Kagoshima, Japan.
| | - Shozo Sonoda
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.,Japan-Clinical Retina Study (J-CREST) Group, Kagoshima, Japan
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Demirel S, Yanık Ö, Özcan G, Batıoğlu F, Özmert E. A comparative study on the choroidal vascularity index and the determination of cut-off values in the pachychoroid spectrum diseases. Jpn J Ophthalmol 2021; 65:482-491. [PMID: 33675486 DOI: 10.1007/s10384-021-00829-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 01/14/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the cut-off levels for choroidal thickness and choroidal vascularity index (CVI) to differentiate among pachychoroid spectrum diseases. STUDY DESIGN A retrospective comparative study METHODS: A total of 143 eyes were included. Of these 29 had uncomplicated pachychoroid (UCP), 29 had pachychoroid pigment epitheliopathy (PPE), 25 had pachychoroid neovasculopathy (PNV), 30 had central serous chorioretinopathy (CSC), and 30 had polypoidal choroidal vasculopathy (PCV). The choroidal areas were measured with ImageJ software. The CVI, the proportion of the luminal area to the total choroidal area, was assessed. RESULTS The cut-off points of central choroidal thickness were determined as 360 µm for the PPE and PCV group pair (p < 0.001), 422 µm for the PNV and CSC group pair (p = 0.026), 271 µm for the PNV and PCV group pair (p < 0.001), and 341 µm for the CSC and PCV group pair (p < 0.001). The cut-off points of CVI were 72.7 for the PPE and PCV group pair (p < 0.001), 74.7 for the PNV and CSC group pair (p = 0.005), 72.6 for the PNV and PCV group pair (p = 0.001), and 73.6 for the CSC and PCV group pair (p < 0.001). CONCLUSION Pachychoroid spectrum may be composed of a combination of distinct choroidal diseases with different vascular and structural characteristics.
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Affiliation(s)
- Sibel Demirel
- Department of Ophthalmology, Ankara University School of Medicine, Mamak Street Vehbi Koç Eye Hospital, Dikimevi, Ankara, Turkey.
| | - Özge Yanık
- Department of Ophthalmology, Ankara University School of Medicine, Mamak Street Vehbi Koç Eye Hospital, Dikimevi, Ankara, Turkey
| | - Gökçen Özcan
- Department of Ophthalmology, Ankara University School of Medicine, Mamak Street Vehbi Koç Eye Hospital, Dikimevi, Ankara, Turkey
| | - Figen Batıoğlu
- Department of Ophthalmology, Ankara University School of Medicine, Mamak Street Vehbi Koç Eye Hospital, Dikimevi, Ankara, Turkey
| | - Emin Özmert
- Department of Ophthalmology, Ankara University School of Medicine, Mamak Street Vehbi Koç Eye Hospital, Dikimevi, Ankara, Turkey
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Variation of vortex veins at the horizontal watershed in normal eyes. Graefes Arch Clin Exp Ophthalmol 2021; 259:2175-2180. [PMID: 33625563 DOI: 10.1007/s00417-021-05130-2] [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: 08/05/2020] [Revised: 12/28/2020] [Accepted: 02/15/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To assess the vascular pattern of choroidal vortex veins at the horizontal watershed zone in normal eyes using optical coherence tomography (OCT). METHODS We retrospectively studied 207 normal eyes of 207 patients whose fellow eyes were diagnosed with unilateral retinal diseases without choroidal involvement. Venous anastomosis between the superior and inferior vortex veins and deviation of the horizontal watershed zone were evaluated using 12 × 12-mm en face OCT images. Central choroidal thickness (CCT) was measured on B-mode OCT images. RESULTS Vortex vein anastomosis was observed in 92 eyes (44.4%) at the horizontal watershed zone. Superior or inferior deviation of the horizontal watershed was ascertained in 69 eyes (33.3%). The frequency of the anastomosis and deviation did not differ significantly between age groups (P = 0.56 and 0.96, respectively). Mean CCT of all eyes was 221 ± 80 μm. CCT was significantly greater in eyes with anastomosis than in those without (233 ± 73 μm vs 210 ± 83 μm, P < 0.05). However, CCT did not differ significantly between eyes with and without deviation of the horizontal watershed zone (223 ± 74 μm vs 219 ± 82 μm). CONCLUSIONS Venous anastomosis at the horizontal watershed zone as well as superior or inferior deviation of the zone were frequently observed in normal eyes. CCT was greater in eyes with than in those without anastomosis, suggesting subclinical vortex vein congestion.
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Matsumoto H, Mukai R, Hoshino J, Oda M, Matsuzaki T, Ishizaki Y, Shibasaki K, Akiyama H. Choroidal congestion mouse model: Could it serve as a pachychoroid model? PLoS One 2021; 16:e0246115. [PMID: 33507997 PMCID: PMC7843010 DOI: 10.1371/journal.pone.0246115] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/13/2021] [Indexed: 01/18/2023] Open
Abstract
Pachychoroid spectrum diseases have been described as a new clinical entity within the spectrum of macular disorders. “Pachychoroid” is defined as choroidal thickening associated with dilated outer choroidal vessels often showing retinal pigment epithelium (RPE) degeneration. Although various clinical studies on the pachychoroid spectrum diseases have been conducted, the pathophysiology of pachychoroid has yet to be fully elucidated. In this study, we attempted to establish a mouse model of pachychoroid. We sutured vortex veins in eyes of wild type mice to imitate the vortex vein congestion in pachychoroid spectrum diseases. Fundus photography and ultra-widefield indocyanine green angiography showed dilated vortex veins from the posterior pole to the ampulla in eyes after induction of choroidal congestion. Optical coherence tomography and tissue sections presented choroidal thickening with dilatation of choroidal vessels. The RPE-choroid/retina thickness ratios on the tissue sections in the treated day 1 and day 7 groups were significantly greater than that in the control group (0.19±0.03 and 0.16±0.01 vs. 0.12±0.02, P<0.05 each). Moreover, immunohistochemistry using RPE flatmount revealed focal RPE degeneration in the treated eyes. Furthermore, inflammatory response-related genes were upregulated in eyes with choroidal congestion induction, and macrophages migrated into the thickened choroid. These results indicated that vortex vein congestion triggered some pachychoroid features. Thus, we have established a choroidal congestion mouse model by suturing vortex veins, which would potentially be useful for investigating the pathophysiology of pachychoroid spectrum diseases.
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Affiliation(s)
- Hidetaka Matsumoto
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Japan
- * E-mail:
| | - Ryo Mukai
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Junki Hoshino
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Mai Oda
- Department of Molecular and Cellular Neurobiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toshiyuki Matsuzaki
- Department of Anatomy and Cell Biology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yasuki Ishizaki
- Department of Molecular and Cellular Neurobiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Koji Shibasaki
- Laboratory of Neurochemistry, Graduate School of Human Health Science, University of Nagasaki, Nagasaki, Japan
| | - Hideo Akiyama
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Japan
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Quantitative measures of vortex veins in the posterior pole in eyes with pachychoroid spectrum diseases. Sci Rep 2020; 10:19505. [PMID: 33177540 PMCID: PMC7658995 DOI: 10.1038/s41598-020-75789-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/14/2020] [Indexed: 11/16/2022] Open
Abstract
Pachychoroid spectrum diseases have attracted increasing attention, though their pathophysiology has yet to be fully elucidated. In this study, we assessed the vascular diameters of vortex veins in pachychoroid spectrum diseases such as central serous chorioretinopathy (CSC), pachychoroid neovasculopathy without polypoidal lesions (PNV), and pachychoroid neovasculopathy with polypoidal lesions (polypoidal choroidal vasculopathy: PCV). In a retrospective case series of 94 eyes with CSC, 60 eyes with PNV and 57 with PCV, we binarized en face optical coherence tomography (OCT) images of choroidal vortex veins and analyzed the mean diameter of vortex veins. The presence of anastomosis between the superior and inferior vortex veins and central choroidal thickness (CCT) were also evaluated using OCT images. CSC showed significantly larger mean diameter of vortex veins than PCV (P < 0.05). Anastomosis between superior and inferior vortex veins was observed in over 90% of eyes with each pachychoroid spectrum disease. The patients with CSC were the youngest, followed by PNV patients, and then patients with PCV. The largest CCT values were observed in CSC eyes, followed by PNV eyes, and then PCV eyes. CCT correlated with the mean diameter of vortex veins (rs = 0.51, P < 0.01). These findings suggest that congestion of vortex veins might show gradual amelioration corresponding to the development of anastomosis between the superior and inferior vortex veins during the course of progression of pachychoroid spectrum diseases. Moreover, the mean diameter of vortex veins can be used as a parameter indicating choroidal congestion.
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Sato M, Minami S, Nagai N, Suzuki M, Kurihara T, Shinojima A, Sonobe H, Akino K, Ban N, Watanabe K, Uchida A, Shinoda H, Tsubota K, Ozawa Y. Association between axial length and choroidal thickness in early age-related macular degeneration. PLoS One 2020; 15:e0240357. [PMID: 33035241 PMCID: PMC7546466 DOI: 10.1371/journal.pone.0240357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 09/24/2020] [Indexed: 11/19/2022] Open
Abstract
The clinical course of age-related macular degeneration (AMD) is related to choroidal conditions, and can be determined by the evaluation of the central choroidal thickness (CCT). The aim of this study was to determine the association between the axial length (AL) and choroidal thickness in AMD by measuring these parameters in patients with and without AMD. Seventy eyes of 70 patients (34 men and 36 women; age, 64-88 years; mean age, 77.0 ± 6.5 years) who underwent cataract surgery from February 2015 to March 2020 at the Department of Ophthalmology, Keio University School of Medicine were retrospectively analyzed. The AMD group (29 patients, 29 eyes) included eyes with early AMD, whereas the control group (41 patients, 41 eyes) included those without ocular diseases other than cataract. Optical coherence tomography images were used to measure the CCT and the choroidal vessel diameter (CVD). The IOL Master was used to measure the AL. The results revealed that mean CCT was greater in the AMD group (238.3 ± 108.3 μm) compared with the age-matched control group (187.2 ± 66.8 μm) (p = 0.03). The CCT was negatively correlated with AL in the overall sample (r = -0.42, p = 0.001), the AMD group (r = -0.42, p = 0.02), and the control group (r = -0.42, p = 0.006). Note that all eyes with CCT > 350 μm were included in the AMD group. CCT and CVD were positively correlated in the overall sample (r = 0.76, p < 0.001) as well as in the individual groups (AMD: r = 0.82, p < 0.001; control: r = 0.76, p = 0.004). Given that CCT is an important parameter for predicting the prognosis of subfoveal diseases, routine evaluation of AL may be valuable for a better understanding of the pathogenesis of AMD.
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Affiliation(s)
- Maho Sato
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Sakiko Minami
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Norihiro Nagai
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- Laboratory of Retinal Cell Biology, Keio University School of Medicine, Tokyo, Japan
| | - Misa Suzuki
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Toshihide Kurihara
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Ari Shinojima
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Hideki Sonobe
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kunihiko Akino
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Norimitsu Ban
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuhiro Watanabe
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Atsuro Uchida
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Hajime Shinoda
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Yoko Ozawa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- Laboratory of Retinal Cell Biology, Keio University School of Medicine, Tokyo, Japan
- Department of Ophthalmology, St. Luke’s International Hospital, Tokyo, Japan
- St. Luke’s International University, Tokyo, Japan
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