Spectral-domain optical coherence tomography findings in polypoidal choroidal vasculopathy suggest a type 1 neovascular growth pattern

Optical Coherence Tomography Characteristics for Differentiating Scars in Type 1 (Polypoidal Choroidal Vasculopathy (PCV)) and Type 2 (Classical) Macular Neovascularization (MNV) in Age-Related Macular Degeneration (AMD)

PURPOSE

This study aimed to assess the optical coherence tomography (OCT) characteristics for differentiating scars in the scarred stages of macular neovascularization (MNV) in age-related macular degeneration (AMD).

METHODS

Medical records of 20 patients, 10 in each group with type 1 and type 2 MNV, were selected for the study. Participants chosen were above 50 years of age and underwent comprehensive eye examination alongside indocyanine green angiography (ICGA), fundus fluorescence angiography (FFA), and Spectralis optical coherence tomography (SOCT) (Heidelberg Engineering, Germany), respectively. The qualitative and quantitative OCT measurements, such as the frequency of outer retinal tubulations, presence of cystoid spaces, scar area, choroid thickness, retinal thickness, presence of disorganization in retinal layers (DRIL), foveal contour, and involvement of retinal layers in the scar, were meticulously evaluated and compared between the two groups.

RESULTS

Significant disparities between type 1 MNV and type 2 MNV in choroidal thickness were identified in the nasal and superior quadrants within 1 mm, in the superior quadrant within 3 mm, and in all quadrants except the inferior quadrant within 6 mm. Overall, type 2 MNV showed thinner choroid than type 1 MNV.

CONCLUSION

Although there are several overlapping features noticed between the groups, the OCT was able to pick up characteristic features that aid in differentiating type 1 (polypoidal choroidal vasculopathy (PCV)) and type 2 (classic) MNV in AMD. This precise differentiation has the potential to assist ophthalmologists in making well-informed decisions, thereby enhancing patient care.

Recent Advances in Imaging Polypoidal Choroidal Vasculopathy with Swept-Source Optical Coherence Tomography Angiography

The gold standard for polypoidal choroidal vasculopathy (PCV) diagnosis is indocyanine green angiography (ICGA), but optical coherence tomography angiography (OCTA) has shown promise for PCV imaging in recent years. However, earlier generations of OCTA technology lacked the diagnostic efficacy to replace ICGA. Swept-source optical coherence tomography angiography (SS-OCTA), the latest generation of OCTA technology, has significantly improved penetrating ability, scanning speed, scanning range, and overall image quality compared with earlier generations of OCTA. SS-OCTA reveals a "tangled vasculature" pattern of polypoidal lesions (PLs), providing evidence that they are neovascular rather than aneurysmal structures. New choroidal biomarkers, such as the choriocapillaris flow void (FV), have been identified to explain the development of PCV lesions. Although no direct comparison between SS-OCTA and previous OCTA generations in terms of diagnostic capability has been performed, SS-OCTA has shown several advantages in differential diagnosis and monitoring early reactivation for PCV. These improvements make SS-OCTA a valuable tool for PCV diagnosis and follow-up, and it may become more important for this disease in the future. This review summarized recent advances in PCV morphology and structure, as well as the possible pathogenesis based on SS-OCTA findings. The value of SS-OCTA for PCV management is discussed, along with remaining issues, to provide an updated understanding of PCV and OCTA-guided management.

Diagnostic Value of Spectral-Domain Optical Coherence Tomography for Polypoidal Choroidal Vasculopathy: A Systematic Review and Meta-Analysis

Purpose

To evaluate the diagnostic value of spectral-domain optical coherence tomography (SD-OCT) for polypoidal choroidal vasculopathy (PCV).

Methods

A search of electronic databases was conducted from 2010 to 2021 to review the relevant literature on SD-OCT to identify PCV and other lesions causing serious or serosanguinous retinal pigment epithelial detachment (PED), specifically neovascular age-related macular degeneration (nvAMD). The QUADAS-2 scale was used to evaluate the quality of the literature. We performed a meta-analysis, including heterogeneity tests, analyze and synthesize the study data, meta-regression analysis, subgroup analysis, Fagan's plot, sensitivity analysis and publication bias tests.

Results

A total of 12 related studies involving 1,348 eyes were included in this study, and the random-effects model was used for meta-analysis. The results showed that the pooled sensitivity of SD-OCT in the diagnosis of PCV was 0.87 (95% CI: 0.84–0.89), the pooled specificity was 0.83 (95% CI: 0.80–0.86), and the pooled positive/negative likelihood ratios were 5.38 (95% CI: 3.28–8.80) and 0.16 (95% CI: 0.10–0.25), respectively. The diagnostic odds ratio (DOR) was 36.07 (95% CI: 15.98–81.40), and the area under the sROC curve (AUC) was 0.9429. When the pre–test probability was set at 20%, the post-test positive and negative probabilities were 58% and 4%, respectively. Meta-regression indicated that race was the primary source of heterogeneity (P <0.05). The Deeks' funnel plot showed no significant publication bias in this study (P>0.05).

Conclusion

SD-OCT has high sensitivity and specificity for the diagnosis of PCV, as well as significant clinical applicability. Since color fundus photography (CFP) is more clinically available and can improve the diagnostic efficacy, we recommend SD-OCT combined with CFP to diagnose PCV, especially without indocyanine green angiography (ICGA).

Systematic Review Registration

https://inplasy.com/inplasy-2021-12-0048/, identifier: INPLASY2021120048.

Pachychoroid spectrum disease

Recent improvements in ophthalmic imaging have led to the identification of a thickened choroid or pachychoroid to be associated with a number of retinal diseases. The number of conditions linked to this phenotype has continued to widen with specific endophenotypes found within the pachychoroid spectrum. The spectrum includes choroidal features such as focal or diffuse choroidal thickening and thinning of the overlying inner choroid, and choroidal hyperpermeability as demonstrated by indocyanine green angiography. In addition, these diseases are associated with overlying retinal pigmentary changes and retinal pigment epithelial dysfunction and may also be associated with choroidal neovascularization. This article provides a comprehensive review of the literature looking at diseases currently described within the pachychoroid spectrum including central serous chorioretinopathy, pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy/aneurysmal type 1 neovascularization, peripapillary pachychoroid disease and focal choroidal excavation. We particularly focus on clinical imaging, genetics and pathological findings in these conditions with the aim of updating evidence suggesting a common aetiology between diseases within the pachychoroid spectrum.

Visual Parameters and Retinal Morphology for Polypoidal Choroidal Vasculopathy Pre- and Post-Intravitreal Ranibizumab with or without Photodynamic Therapy: A Short-Term Prospective Study

The objective of this study was to compare visual parameters and retinal layers’ morphology pre-treatment (baseline) and 6 months post-treatment in polypoidal choroidal vasculopathy (PCV) eyes. A single centre, longitudinal, prospective study was conducted at a public tertiary hospital of Malaysia. Visual parameters including distance and near visual acuity (DVA and NVA), contrast sensitivity (CS), reading speed (RS), and different qualitative and quantitative optical coherence tomography (OCT) parameters were evaluated pre- and 6 months post-treatment. Thirty-three naïve PCV eyes of 32 patients (mean age of 67.62 years) were evaluated pre- and post-treatment of intravitreal ranibizumab with and without photodynamic therapy. After treatment, sub retinal fluid decreased from 27 eyes (84.35%) at baseline to 7 eyes (21.88%) at 6 months while pigment epithelium detachment decreased from 32 eyes (100%) at base line to 15 eyes (46.87%) at 6 months. Mean pre-treatment quantitative morphological OCT retinal parameters including thickness and volume of central sub field, center thickness, center minimum, and maximum thickness reduced significantly. Similarly, all visual parameters including DVA, NVA, CS, and RS showed statistically significant improvement. While 89% of the eyes showed improvement in CS, 78%, 71%, and 65% of the eyes showed improvement in NVA, RS, and DVA, respectively. Thus, CS was the most treatment responsive visual parameter.

Central serous chorioretinopathy: An update on risk factors, pathophysiology and imaging modalities

Central serous chorioretinopathy (CSC) is a common form of vision loss, typically seen in working-age men. The pathophysiology behind CSC still eludes us, however significant advances have been made in understanding this disease over the last decade using information from genetic and cell-based studies and imaging modalities. This review aims to give an overview of the current pathophysiology hypotheses surrounding CSC in addition to future directions in cellular work from human induced pluripotent stem cell derived choroidal endothelial cells from CSC patients. Furthermore, this review will provide the reader with an update on the clinical aspects of CSC including risk factors, diagnostic challenges and findings from multimodal imaging.

Influence of pigment epithelial detachment on visual acuity in neovascular age-related macular degeneration

Pigment epithelial detachment (PED), the anatomical separation of the retinal pigment epithelium from the Bruch membrane, is common in many chorioretinal diseases, including neovascular age-related macular degeneration. PED is present in about 30% to 80% of neovascular age-related macular degeneration patients based on the CATT, EXCITE, and VIEW studies. The influence of PED on visual acuity is controversial as a result of inconsistent results reported by various studies. With advances in imaging technologies, it is possible to evaluate not only the presence or absence of PED, but also detailed quantitative parameters, such as height, width, greatest linear diameter, area, volume, and reflectivity within the PED. We performed a comprehensive literature review to evaluate the relationship of PED with visual acuity. In summary, the presence or persistence of a PED may still be compatible with relatively good visual acuity. There is no strong evidence that the presence of a PED or aspects of its morphology has a significant impact on visual acuity. The presence of a PED may be predictive of the need for more regular treatment. More well-designed studies with standardized PED definitions and classifications are needed to evaluate the relationship between PED and visual acuity.

Latest Developments in Polypoidal Choroidal Vasculopathy: Epidemiology, Etiology, Diagnosis, and Treatment

Polypoidal choroidal vasculopathy (PCV) is a condition characterized by multiple, recurrent, serosanguineous pigment epithelial detachments, and neurosensory retinal detachments due to abnormal aneurysmal neovascular lesions. It is generally considered as a variant of neovascular age-related macular degeneration, but there are some differences between the clinical presentation, natural history, and treatment response between patients with PCV and typical neovascular age-related macular degeneration patients. Over the past decade, new research and technological advancements have greatly improved our understanding of the PCV disease process and the management of PCV. This review aims to summarize the recent research findings to highlight the epidemiology, pathogenesis, genetics, the application of various diagnostic tools for PCV, and the available treatment options for PCV.

Pharmacological Advances in the Treatment of Age-related Macular Degeneration

Age-related macular degeneration is an acquired degenerative disease that is responsible for severe loss of vision in elderly people. There are two types: dry age-related macular degeneration and wet age-related macular degeneration. Its treatment has been improved and tries to be tailored in the future. The aim of this review is to summarize the pharmacological advances in the treatment of age-related macular degeneration. Regarding dry AMD, there is no effective treatment to reduce its progression. However, some molecules such as lampalizumab and eculizumab were under investigation, although they have shown low efficacy. Herein, in an attempt to prevent dry AMD progression, the most important studies suggested increasing the antioxidants intake and quitting the smoke habit. On the other hand, wet AMD has more developed treatment. Nowadays, the gold standard treatment is anti-VEGF injections. However, more effective molecules are currently under investigation. There are different molecules under research for dry AMD and wet AMD. This fact could help us treat our patients with more effective and lasting drugs but more clinical trials and safety studies are required in order to achieve an optimal treatment.

Vision-Related Quality of Life, Anxiety and Depression in Congolese Patients with Polypoidal Choroidal Vasculopathy

OBJECTIVE

To assess the impact of polypoidal choroidal vasculopathy (PCV) on quality of life (QoL) and mental health in a cohort of Congolese patients.

METHODS

Fifteen PCV patients and 26 age-matched controls completed the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and the Hospital Anxiety and Depression Scale (HADS) questionnaire. Outcome measures were QoL and HADS scores, frequency of anxiety and depression, correlations between best-corrected distance visual acuity (BCDVA) and QoL and HADS scores. Risk factors for anxiety and depression were also determined.

RESULTS

The QoL composite score was (54.9 ± 24.2) in patients and (94.5 ± 4.5) in controls, p <.001. Patients scored higher on HADS-A (9.5 ± 3.4) and HADS-D (6.7 ± 4.7) than controls (3.0 ± 2.7 and 1.5 ± 2.6), all p <.001. Anxiety and depression were present in 73.3% and 46.7% of patients, respectively, versus 1% each of controls (p <.001). Every unit improvement in best eye's BCDVA increased QoL composite score by 24.3, but decreased HADS-D by 5.9. Macular lesions decreased QoL by 34.5 while increasing HADS-A and HADS-D scores by 4.2 and 4.4, respectively. A history of stroke also increased the HADS-A score by 5.9.

CONCLUSIONS

PCV impairs the QoL and induces both anxiety and depression in Congolese PCV patients. Screening for QoL, anxiety and depression in PCV patients at first presentation will help detect those in need of psychological support.

Appearance of Polypoidal Lesions in Patients With Polypoidal Choroidal Vasculopathy Using Swept-Source Optical Coherence Tomographic Angiography

Importance

Polypoidal choroidal vasculopathy (PCV) is a major cause of visual loss worldwide, particularly in Asia, and the appropriate understanding of the structures in PCV previously described as polypoidal lesions is important for understanding their pathogenesis, diagnosis, and prognosis.

Objective

To report the morphologic characteristics of polypoidal lesions and their association with branching vascular networks (BVNs) in eyes with PCV using swept-source optical coherence tomographic angiography (SS-OCTA).

Design, Setting, and Participants

This cross-sectional observational study included 20 participants recruited from Shanghai General Hospital with a diagnosis of PCV based on the presence of focal hyperfluorescent spots on indocyanine green angiography (ICGA). Data were collected from December 1, 2017, to September 1, 2018, and analyzed from June 1 through September 30, 2018.

Main Outcomes and Measures

Polypoidal lesions in eyes with PCV were characterized using multimodal imaging that included fundus photography, fluorescein angiography, ICGA, SS-OCT, and SS-OCTA, and the images were anatomically aligned. Subfoveal choroidal thickness was manually measured as the distance between the Bruch membrane and the sclerochoroidal interface on the SS-OCT images.

Results

Of the 20 Asian patients, 5 (25%) were women and 15 (75%) were men. The mean (SD) age was 61.1 (7.6) years, and the mean (SD) logMAR visual acuity was 0.358 (0.294) (Snellen equivalent, 20/50 [20/40]). Twenty-three eyes underwent imaging and were diagnosed with PCV. Indocyanine green angiography identified 43 polypoidal lesions, and all corresponded to the structures that appeared as clusters of tangled vessels on SS-OCTA images. In addition, SS-OCTA detected 16 tangled vascular structures not seen on ICGA. Branching vascular networks were detected on SS-OCTA imaging in all eyes, but ICGA identified BVNs in only 17 of 23 eyes (74%). Of the 43 tangled vascular structures, 40 (93%) were located at the edge of a BVN and 3 (7%) were associated with type 2 neovascularization.

Conclusions and Relevance

In eyes with PCV undergoing SS-OCTA imaging, previously described polypoidal lesions may appear as tangled vascular structures associated with BVN or type 2 neovascularization. The identification of polypoidal lesions in patients with PCV as neovascular tangles rather than actual polypoidal lesions or aneurysmal dilatations may help facilitate understanding of their pathogenesis and response to treatment.

Optical Coherence Tomography Angiography for Assessment of the 3-Dimensional Structures of Polypoidal Choroidal Vasculopathy

Importance

Investigating the quantitative 3-dimensional (3-D) anatomy of polypoidal complex is important for a better understanding of the pathogenesis of polypoidal choroidal vasculopathy (PCV).

Objective

To quantitatively evaluate the 3-D characteristics of polypoidal structures, branching vascular networks (BVNs), and origin of PCV using optical coherence tomography angiography (OCTA) and multiple image systems.

Design, Setting, and Participants

A prospective, observational study was conducted in 47 consecutive Taiwanese patients (47 eyes) from May 21, 2015, to April 30, 2017. All participants were scanned with the Optovue-RTVue-XR-Avanti OCTA system. Patients in whom PCV was identified on OCTA were examined to define characteristics and structures of the original spouting vessels (stalks) from the choroid, polypoidal structures, and BVNs on OCTA.

Main Outcomes and Measures

Quantitative analysis of 3-D structures of the polypoidal complex.

Results

Among the 47 patients, the mean (SD) patient age was 68.9 (8.0) years, and 28 (59.6%) men were included. Clear images of polypoidal structures could be detected in 17 eyes (36.2%, 22 polypoidal structures), BVNs in 26 eyes (55.3%, 26 tufts of BVNs), and stalks of origin from the choroid in 26 eyes (55.3%, 26 stalks) on the en face plane on OCTA. All polypoidal structures were found at a mean (SD) height of 45.3 (36.1) μm above the retinal pigment epithelium (RPE) reference plane that was preset by the machine, while the BVNs were found at a mean (SD) depth of 28.6 (14.2) μm below the RPE reference plane and the choroidal stalks at 80.4 (24.4) μm below RPE reference plane. The mean (SD) thickness of polypoidal structures was 38.4 (15.5) μm and of BVNs, 60.2 (25.0) μm. The polypoidal structures were all above the Bruch membrane within the dome of the RPE detachment, the choroidal stalks were all in the choroid layer. The BVNs could be either above (up to 18 μm), within, or below (up to 28 μm) the Bruch membrane and were in proximity to the double layers of flattened RPE detachment.

Conclusions and Relevance

These results demonstrate a 3-D architecture of PCV that may be helpful for a better understanding of the anatomy, pathophysiology, and pathogenesis of PCV.

Comparison of optical coherence tomography angiography and green indocyanine angiography in polypoidal choroidal vasculopathy: A prospective study

PURPOSE

To compare optical coherence tomography angiography (OCTA) and indocyanine green angiography (ICGA) findings in polypoidal choroidal vasculopathy (PCV) according to polyp type, polyp size and pigment epithelial detachment (PED) size.

METHOD

Seventeen patients with PCV were included this study. The participants were divided into two groups according to ICGA images. Participants who had type I PCV formed group 1, and group 2 was comprised of patients with type II PCV. OCTA was performed for all participants. Polyp detection rates with OCTA and factors affecting this detection were assessed.

RESULTS

The mean age of all patients was 68.85±4.77 years (group 1 70.4±2.54 years, group 2 67.45±5.93 years). The rate of polyps seen in OCTA images was statistically significantly correlated with polyp type, polyp size, and PED size (r=0.633, p=0.002; r=0.64, P=0.001 and r=0.59, p<0.001, respectively). In group 1, the mean polyp size was 230.8±82.94μm, and the mean PED size was 161.3±73.87μm. In group 1, 10 patients with PCV were detected with ICGA, while only 1 (10%) PCV was detected with OCTA. In group 2, the mean polyp size was 387.90±245.90μm, and the mean PED size was 345.18±276.26μm. In group 2, 11 patients with PCV were detected with ICGA, while 8 (72.7%) of these patients were detected using OCTA.

CONCLUSIONS

OCTA showed a greater percentage of detection of type II PCV than type I PCV. Polyp and PED size are important for the detection of PCV using OCTA.

Polypoidal choroidal vasculopathy: a comprehensive clinical update

Polypoidal choroidal vasculopathy as a disease is yet to be comprehended completely. The clinical features consisting of huge serosanguineous retinal pigment epithelial and neurosensory layer detachments, although unique may closely mimick neovascular age-related macular degeneration and other counterparts. The investigative modalities starting from indocyanine angiography to optical coherence tomography angiography provide diagnostic challenges. The management strategies based on the available therapies are plenty and not vivid. A detailed review with clarifying images has been compiled with an aim to help the readers in getting a better understanding of the disease.

Microperimetry and multimodal imaging in polypoidal choroidal vasculopathy

Polypoidal choroidal vasculopathy (PCV) is a degenerative macular disease. The study determined the topographical concordance in the areal extent of PCV, defined by indocyanine green angiography (ICGA), and the corresponding outcomes from spectral-domain optical coherence tomography (SD-OCT) and microperimetry, in 25 individuals (25 eyes) who had undergone 3 months of anti-vascular endothelial growth factor treatment. The differential light sensitivity within 10° eccentricity was evaluated by Pattern Deviation probability analysis. The concordances and proportional areal extents of the abnormality for ICGA, SD-OCT and microperimetry were compared. The concordance in the areal extent between all three modalities was 59%. The median concordance between ICGA and microperimetry was 60%; between ICGA and SD-OCT, 70%; and between SD-OCT and microperimetry, 72%. SD-OCT and microperimetry each identified a greater areal extent (>20%) compared to ICGA in 13 and 19 eyes, respectively. A greater areal extent (>20%) was present in 9 eyes for microperimetry compared to SD-OCT and in 5 eyes for SD-OCT compared to microperimetry. SD-OCT and microperimetry each identified a greater area of abnormality than ICGA which supports the clinical utility of SD-OCT. Strong concordance was present between SD-OCT and microperimetry; however, microperimetry identified additional areas of functional abnormality.

The Use of Vascular Endothelial Growth Factor Inhibitors and Complementary Treatment Options in Polypoidal Choroidal Vasculopathy: A Subtype of Neovascular Age-Related Macular Degeneration

Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular age-related macular degeneration (AMD; nAMD) which occurs more commonly in Asian populations as compared to Caucasians. PCV and nAMD share pathological mechanisms, including pathological expression of vascular endothelial growth factor (VEGF). The advent of anti-vascular endothelial growth factor (VEGF) revolutionized the treatment of nAMD. Despite being a subtype of nAMD, PCV responds less well to VEGF inhibitors; thus, photodynamic therapy (PDT) in combination with anti-VEGF treatment may be considered. This review aims to summarize the current evidence for the treatment of PCV, especially whether VEGF inhibitors should be used alone or in combination with PDT.

Polypoidal choroidal vasculopathy: Pearls in diagnosis and management

Polypoidal choroidal vasculopathy (PCV) is increasingly recognized as an important cause of exudative maculopathy in Asians as against Wet age-related macular degeneration in Caucasians. A panel of retinal experts methodically evaluated pertinent updated literature on PCV with thorough PubMed/MEDLINE search. Based on this, the panel agreed upon and proposed the current consensus recommendations in the diagnosis (clinical and imaging), management and follow-up schedule of PCV. Diagnosis of PCV should be based on the gold standard indocyanine green angiography which demonstrates early nodular hyperfluorescence signifying the polyp with additional features such as abnormal vascular network (AVN). Optical coherence tomography is an excellent adjuvant for diagnosing PCV, monitoring disease activity, and decision-making regarding the treatment. Current treatment modalities for PCV include photodynamic therapy, anti-vascular endothelial growth factor agents, and thermal laser. Choice of specific treatment modality and prognosis depends on multiple factors such as the location and size of PCV lesion, presence or absence of polyp with residual AVN, amount of submacular hemorrhage, presence or absence of leakage on fundus fluorescein angiography, visual acuity, and so on. Current recommendations would be invaluable for the treating physician in diagnosing PCV and in formulating the best possible individualized treatment strategy for optimal outcomes in PCV management.

Understanding aneurysmal type 1 neovascularization (polypoidal choroidal vasculopathy): a lesson in the taxonomy of 'expanded spectra' - a review

The term aneurysmal type 1 neovascularization is derived from terminology, which is established in the literature but has fallen out of use. We believe that aneurysmal type 1 neovascularization accurately describes the lesions which define the entity known as polypoidal choroidal vasculopathy (PCV). Over the last three decades, the clinical spectrum of PCV has expanded to recognize the occurrence of the aneurysmal (polypoidal) lesions in different contexts, resulting in a complex and unwieldy taxonomy based sometimes on circumstantial findings rather than mechanistic considerations. Advances in multimodal imaging provides increasingly convincing evidence that the lesions which define various forms of PCV are indeed vascular and arise from type 1 neovascular networks. The understanding of PCV as type 1 neovascularization with aneurysms renews focus on the question as to why some patients with type 1 neovascularization develop aneurysms while others do not. Conceptual themes and potential for further study are discussed.

Type 2 choroidal neovascularisation in polypoidal choroidal vasculopathy: a retrospective case series

BACKGROUND AND OBJECTIVE

To demonstrate the coexistence of polypoidal choroidal vasculopathy (PCV) with type 2 neovascularisation (NV), we used multimodal imaging, including spectral-domain optical coherence tomography angiography (SD-OCTA), to identify both types of lesions in the same eye.

STUDY DESIGN

This retrospective case series reviewed patients with PCV diagnosed with indocyanine green angiography (ICGA), fluorescein angiography (FA), SD-OCT and SD-OCTA.

RESULTS

15 eyes of 14 patients were imaged and diagnosed with PCV by ICGA. ICGA identified polyps in all these eyes, while SD-OCTA imaging identified polypoidal lesions in only 11 (73%) of these eyes with PCV. Branching vascular networks (BVNs) were detected in 12 eyes (80%) by ICGA and SD-OCTA. Type 2 NV was detected in four eyes (27%) by FA and SD-OCTA. In these eyes, a combination of polyps, BVNs and type 2 NV were detected using FA, ICGA and SD-OCTA.

CONCLUSION

BVN and type 2 NV can coexist in the same PCV eye and communicate with each other. This suggests that polyps may represent a structural variant of neovascular tissue rather than a distinct pathogenic process in NV.

Evaluating Polypoidal Choroidal Vasculopathy With Optical Coherence Tomography Angiography

Purpose

We observed and analyzed the morphologic characteristics of polypoidal lesions and abnormal branching vascular network (BVN) in patients with polypoidal choroidal vasculopathy (PCV) by optical coherence tomography angiography (OCTA).

Methods

A retrospective observational case series was done of patients with PCV. All patients were scanned with a 70-kHz spectral-domain OCT system using the split-spectrum amplitude-decorrelation angiography (SSADA) algorithm to distinguish blood flow from static tissue. The OCTA images of these patients were compared to those from indocyanine green angiography (ICGA). Semiautomated segmentation was used to further analyze the polypoidal lesion and the BVN.

Results

We studied 13 eyes of 13 patients 51 to 69 years old. A total of 11 patients were treatment-naive. Two patients had multiple anti-VEGF injections and one underwent photodynamic therapy (PDT). Optical coherence tomography angiography was able to detect the BVN in all cases. Using cross-sectional OCTA, BVN locations were shown to be in the space between the RPE and Bruch's membrane. Using en face OCTA, the BVN vascular pattern could be shown more clearly than by ICGA. Polypoidal lesions showed high flow signals in different patterns in 12 cases in the outer retina slab. Using cross-sectional OCTA, the polyps were shown to be just below the top of the pigment epithelial detachment (PED). In one case, the polypoidal lesion was not detectable at the outer retina slab.

Conclusions

Optical coherence tomography angiography is a noninvasive imaging tool for detecting vascular changes in PCV. Branching vascular networks showed more clearly on OCTA than on ICGA. Polypoidal lesions had variable patterns on OCTA and were not always detected. The OCTA patterns of the polypoidal lesions and the BVN are helpful in understanding the pathology of PCV.

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF POLYPOIDAL CHOROIDAL VASCULOPATHY AND POLYPOIDAL CHOROIDAL NEOVASCULARIZATION

PURPOSE

To describe the use of optical coherence tomography angiography (OCT-A) for evaluating the spectrum of polypoidal vascular diseases.

METHODS

Retrospective observational case series of seven patients with polypoidal choroidal vasculopathy (three cases) or polypoidal choroidal neovascularization (four cases). Optical coherence tomography angiography information was acquired using two different OCT-A devices (the Optovue RTVue XR Avanti SD-OCT and the Spectralis OCT angiography). Flow signals within branching vascular networks, type 1 neovascularization and polyps were evaluated. Comparisons were made between en face and cross-sectional OCT-A images. Vascular information from OCT-A was also compared with indocyanine green angiography.

RESULTS

En face images from OCT-A provided anatomical information about branching vascular networks that were comparable to indocyanine green angiography. Polyps were poorly resolved on en face OCT-A images but were clearly defined on cross-sectional OCT-A images. Cross-sectional OCT-A revealed flow signals within focal regions of the polyps with a significant portion of the polyp lumen being devoid of flow signal. Flow signals from cross-sectional OCT-A images also showed that branching vascular networks, type 1 neovascularization, and polyps were confined to the anatomic compartment between the retinal pigment epithelium and Bruch's membrane. It was not possible to detect leakage on en face or cross-sectional OCT-A.

CONCLUSION

The combination of en face and cross-sectional OCT-A images provides anatomical information about polypoidal structures that is comparable to indocyanine green angiography. OCT-A may be a useful modality for the management of polypoidal diseases. However, the limitations of OCT-A identified in this study suggest that it is not a replacement for indocyanine green angiography.

Optical coherence tomography angiography characteristics of polypoidal choroidal vasculopathy

PURPOSE

To analyse the morphological characteristics of polypoidal choroidal vasculopathy (PCV) on optical coherence tomography angiography (OCT-A).

METHODS

Prospective study with consecutive patients affected with PCV were included. All patients underwent a complete ophthalmological examination including fundus photography, fluorescein angiography, indocyanine green angiography, spectral-domain OCT and OCT-A.

RESULTS

Twelve eyes of 12 patients (mean age 72.6±10.5 years; 4 men and 8 women) were included for analysis. In all eyes (12/12) the segmentation of the choriocapillaris layer on OCT-A revealed the branching vascular network (BVN) as a hyperflow lesion. OCT-A segmentation of the choriocapillaris layer in correspondence of the polypoidal lesion showed in 3/12 eyes (25%) a hyperflow round structure, surrounded by a hypointense halo, and in 9/12 eyes (75%) a hypoflow round structure.

CONCLUSIONS

The OCT-A is a non-invasive imaging modality allowing the visualisation of different structures in PCV. The BVN is constantly clearly detected. The hypoflow round structure appearance of the polyp in OCT-A, is probably due to an unusual blood flow inside the polypoidal lesions, contrasting with the BVN. Further improvement in OCT-A knowledge will provide information on the specificity of the different intensity characteristics in PCV.

SD-OCT findings in polypoidal choroidal vasculopathy

OBJECTIVE

To examine patients with polypoidal choroidal vasculopathy (PCV), using spectral-domain optical coherence tomography (SD-OCT) to characterise and locate the PCV lesions.

PATIENTS AND METHODS

A series of 15 eyes of 10 patients diagnosed with PCV were examined. All eyes were imaged with macular SD-OCT.

RESULTS

SD-OCT cross-sectional scan findings included atypical and typical pigment epithelial detachments (PEDs). Polyps and neovascularisation were located above Bruch membrane. All 15 eyes (100%) showed sub-retinal fluid (SRF) in association with PEDs.

CONCLUSION

These SD-OCT findings located the vascular lesions of PCV in the sub-retinal pigment epithelium (RPE) space, and strongly suggest that PCV is a variant of type 1 neovascularization.