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Polypoidal choroidal vasculopathy in pachychoroid: combined treatment with photodynamic therapy and aflibercept. Int Ophthalmol 2022; 42:601-610. [PMID: 35034223 DOI: 10.1007/s10792-021-02032-4] [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: 01/09/2021] [Accepted: 09/22/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION To evaluate the effects of combined therapy using intravitreal Aflibercept (IVA) and photodynamic therapy (PDT) on polypoidal choroidal vasculopathy related to pachychoroid disease (PPCV). METHODS Patients with PPCV were treated with PDT combined with 3 IVA injections on a monthly basis, followed by pro re nata criteria. The 12-month follow-up consisted of multiple revaluations of visual acuity and SS-OCT parameters of clinical activity. RESULTS Nineteen eyes were included in the study; mean age was 65.5 years. Visual acuity improved after 12 months (0.35 ± 0.25 to 0.2 ± 0.20 logMAR, p = 0.005). Percentage of eyes with intraretinal and subretinal fluid reduced from baseline to the 12-month follow-up (from 52.6 to 10.5%, p = 0.12, and from 89.5 to 5.3% p = 0.0009, respectively). Central retinal and mean macular thicknesses reduced (258 ± 39.6 to 204.8 ± 38.8 μm p = 0.04 and 293.8 ± 32.1 to 248.1 ± 29.6 μm p = 0.017, respectively). Central choroidal and mean choroidal thicknesses also displayed a reduction (328.6 ± 54.9 to 289.8 ± 44.6 μm p = 0.001 and 314.5 ± 55.3 to 287.9 ± 47.6 μm p = 0.015, respectively). The mean number of injections was 4.6/year. CONCLUSION The results support the use of a combined therapy with Aflibercept and PDT in PPCV. This treatment would act in synergy, with anti-VEGF controlling exudation and PDT closing the aneurysmal vessel and reducing choroidal congestion.
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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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Takahashi N, Kunikata H, Yasuda M, Hariya T, Nishiguchi KM, Nakazawa T. Polypoidal choroidal vasculopathy in a case of retinitis pigmentosa, successfully treated with intravitreal aflibercept. Am J Ophthalmol Case Rep 2021; 23:101123. [PMID: 34136721 PMCID: PMC8181791 DOI: 10.1016/j.ajoc.2021.101123] [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: 06/10/2020] [Revised: 01/16/2021] [Accepted: 05/10/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Polypoidal choroidal vasculopathy (PCV) is a subtype of age-related macular degeneration that is seen frequently in Asians. Nevertheless, it is rare for this condition to be combined with retinitis pigmentosa (RP). The purpose of this paper is to present findings from this rare combination in a Japanese patient, and to describe its successful treatment with intravitreal aflibercept (IVA). Observations The patient was a 71-year-old Japanese woman with RP (diagnosed at the age of 30) and PCV. She noticed a decrease in vision in her right eye 6 months previously. Decimal best-corrected visual acuity (BCVA) was 0.05 in her right eye. Optical coherence tomography and indocyanine green angiography (IA) revealed serous retinal detachment (SRD) and PCV in her right eye. The SRD was initially resolved after 3 monthly treatments with IVA, but recurrences began 5 months later, requiring four more treatments with IVA, performed about every 4 months within the next 12 months, for successful resolution. There were no recurrences of PCV in 7 more months of follow-up, as confirmed with IA at the final appointment. Final decimal BCVA in the right eye improved to 0.15. Furthermore, macular retinal sensitivity, measured with microperimetry, increased after the treatment, and RP-related visual field narrowing, determined by Goldmann perimetry, did not progress throughout follow up of 26 months. Conclusion More than 2 years of follow up showed that IVA may be effective for treating PCV, even in RP patients, and can increase central visual function without causing progression of RP-related visual field narrowing.
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Affiliation(s)
- Nana Takahashi
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Japan
| | - Hiroshi Kunikata
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Japan
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Japan
- Corresponding author. Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
| | - Masayuki Yasuda
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Japan
| | - Takehiro Hariya
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Japan
| | - Koji M. Nishiguchi
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Japan
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Japan
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Japan
- Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Japan
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Kang NY, Ra H, Lee K, Lee JH, Lee WK, Baek J. Classification of pachychoroid on optical coherence tomography using deep learning. Graefes Arch Clin Exp Ophthalmol 2021; 259:1803-1809. [PMID: 33616757 DOI: 10.1007/s00417-021-05104-4] [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: 11/12/2020] [Revised: 01/11/2021] [Accepted: 01/26/2021] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Pachychoroid is characterized by dilated Haller vessels and choriocapillaris attenuation that are seen on optical coherence tomography (OCT) B-scans. This study investigated the feasibility of using deep learning (DL) models to classify pachychoroid and non-pachychoroid eyes from OCT B-scan images. METHODS In total, 1898 OCT B-scan images were collected from eyes with macular diseases. Images were labeled as pachychoroid or non-pachychoroid based on strict quantitative and qualitative criteria for multimodal imaging analysis by two retina specialists. DL models were trained (80%) and validated (20%) using pretrained convolutional neural networks (CNNs). Model performance was assessed using an independent test set of 50 non-pachychoroid and 50 pachychoroid images. RESULTS The final accuracy of AlexNet and VGG-16 was 57.52% for both models. ResNet50, Inception-v3, Inception-ResNet-v2, and Xception showed a final accuracy of 96.31%, 95.25%, 93.40%, and 92.61%, respectively, for the validation set. These models demonstrated accuracy on an independent test set of 78.00%, 86.00%, 90.00%, and 92.00%, and an F1 score of 0.718, 0.841, 0.894, and 0.920, respectively. CONCLUSION DL models classified pachychoroid and non-pachychoroid images with good performance. Accurate classification can be achieved using CNN models with deep rather than shallow neural networks.
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Affiliation(s)
- Nam Yeo Kang
- Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Republic of Korea
| | - Ho Ra
- Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Republic of Korea
| | - Kook Lee
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jun Hyuk Lee
- Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Republic of Korea
| | - Won Ki Lee
- Retina Division, Nune Eye Center, Seoul, Republic of Korea
| | - Jiwon Baek
- Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Republic of Korea.
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Invernizzi A, Pellegrini M, Cornish E, Yi Chong Teo K, Cereda M, Chabblani J. Imaging the Choroid: From Indocyanine Green Angiography to Optical Coherence Tomography Angiography. Asia Pac J Ophthalmol (Phila) 2020; 9:335-348. [PMID: 32739938 DOI: 10.1097/apo.0000000000000307] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The choroid is the vascular structure nourishing the retinal pigment epithelium and the outer retina and it plays a key role in the homeostasis of the eye both under physiological and pathological conditions. In the last 20 years we have moved from "guessing" what was happening beyond the retinal pigment epithelium to actually visualize structural and functional changes of the choroid in vivo noninvasively. In this review we describe the state of the art of choroidal imaging, focusing on the multiple techniques available in the clinical and research setting including indocyanine green angiography, labeled-cells angiographies, optical coherence tomography (OCT), enhanced depth imaging, swept source OCT, and OCT angiography. In the first section of the article, we describe their main applications and the basic principles to interpret the imaging results. Increasing evidence suggests that the choroid is much more involved than we used to think in many pathological conditions from uveitis to intraocular tumors, from vascular diseases to age-related macular degeneration. All clinicians should hence know which is the most appropriate imaging investigation to explore the choroid in the disease they are dealing with and how to interpret the results. For this reason the second section of this review summarizes the best imaging approach and the most common findings visible on choroidal imaging in different diseases of the eye.
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Affiliation(s)
- Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia
| | - Marco Pellegrini
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Elisa Cornish
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia
| | - Kelvin Yi Chong Teo
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia
- Singapore National Eye Center, Singapore
- Singapore Eye Research Institute, Singapore
| | - Matteo Cereda
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Jay Chabblani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Yuan MZ, Chen LL, Yang JY, Luo MY, Chen YX. Comparison of OCT and OCTA manifestations among untreated PCV, neovascular AMD, and CSC in Chinese population. Int J Ophthalmol 2020; 13:93-103. [PMID: 31956576 DOI: 10.18240/ijo.2020.01.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 09/17/2019] [Indexed: 01/01/2023] Open
Abstract
AIM To compare the qualitative and quantitative features among untreated polypoidal choroidal vasculopathy (PCV), neovascular age-related macular degeneration (nv-AMD) and central serous chorioretinopathy (CSC) using optical coherence tomography (OCT) and OCT angiography (OCTA). METHODS This retrospective study included 16 eyes with thin-choroid PCV, 18 eyes with thick-choroid PCV, 16 eyes with nv-AMD and 17 eyes with CSC, respectively. The indicators were obtained by OCT and OCTA. RESULTS Sub-foveal choroidal thickness (SFCT) in CSC was thicker compared to other groups (all P<0.05). SFCT in nv-AMD was thicker compared to thin-choroid PCV, but thinner compared with thick-choroid PCV (both P<0.05). As the ratio of thickness of Haller's layer to thickness of SFCT, which of thin-choroid PCV was significantly higher than CSC (P<0.001). Likewise, thick-choroid PCV had significantly higher ratio than nv-AMD (P=0.016) or CSC (P<0.001). There were differences among them in pigment epithelium detachment (PED). The whole-superficial retinal vessel density (RVD), deep RVD and choroidal capillary vessel density (CCVD) in CSC were significantly higher compared to other three groups, respectively (all P<0.05). The whole CCVD in nv-AMD was higher compared to thick-choroid PCV (P=0.032). Cross-sectional local angiographic form was 87.50%, 83.33%, 0 and 35.29% in thin-choroid PCV, thick-choroid PCV, nv-AMD and CSC, respectively. Cross-sectional diffuse angiographic form was 12.50%, 16.67%, 100% and 5.88% in thin-choroid PCV, thick-choroid PCV, nv-AMD and CSC, respectively. CONCLUSION Combination of OCT and OCTA can effectively observe the significant alterations existed in PCV, CSC and nv-AMD, and there are distinctive differences among them. The pathogenesis is not exactly the same between PCV and nv-AMD, or PCV and CSC.
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Affiliation(s)
- Ming-Zhen Yuan
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Lu-Lu Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jing-Yuan Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Ming-Yue Luo
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - You-Xin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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