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Imbalanced choroidal circulation in eyes with asymmetric dilated vortex vein

  • Clinical Investigation
  • Published:
Japanese Journal of Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

Asymmetric dilated vortex vein (ADVV) observed in eyes with pachychoroid spectrum diseases is thought to be due to congestion of choroidal blood flow. The purpose of this study was to quantitatively investigate the blood flow velocity of ADVV using laser speckle flowgraphy (LSFG).

Study design

Retrospective case series.

Methods

This was a retrospective case series with 23 eyes of 18 patients with ADVV on en-face OCT. A pair of choroidal veins from ADVV side (defined as ADVV vein) and non-ADVV side (defined as non-ADVV vein) was selected in each eye under the following criteria: (i) equivalent proximity to the deviated watershed, (ii) does not overlap with retinal blood vessels in the en-face OCT image, (iii) has approximately the same blood vessel diameter. Rubber bands were placed on the selected choroidal veins on the LSFG color map. Mean blur rate (MBR) values of ADVV and non-ADVV veins were statistically compared.

Results

The average MBR was 10.11 ± 1.9 in the ADVV veins and 13.49 ± 6.2 in the non-ADVV veins, showing significantly lower values in the ADVV veins (P = 0.03). The blood vessel diameter of the ADVV was 10.26 ± 3.0 and in the non-ADVV veins, 10.63 ± 2.9 pixels; not significantly different (P = 0.66). The distance from the deviated watershed to the ADVV was 53.3 ± 24.8 and to the non-ADVV veins, 46.80 ± 20.3 pixels; not significantly different (P = 0.41).

Conclusion

In eyes with ADVV, the blood flow velocity in the ADVV veins was lower than in the non-ADVV veins, suggesting anatomical congestion of ADVV.

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Authors and Affiliations

  1. Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan

    Kiriko Hirooka, Michiyuki Saito, Yui Yamashita, Kousuke Noda & Susumu Ishida

  2. Department of Orthoptics, Faculty of Medicine, Fukuoka International University of Health and Welfare, Fukuoka, Japan

    Yuki Hashimoto

  3. Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan

    Nobuhiro Terao & Hideki Koizumi

Authors
  1. Kiriko Hirooka
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  2. Michiyuki Saito
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  3. Yui Yamashita
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  4. Yuki Hashimoto
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  5. Nobuhiro Terao
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  6. Hideki Koizumi
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  7. Kousuke Noda
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  8. Susumu Ishida
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Corresponding author

Correspondence to Michiyuki Saito.

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Conflicts of interest

K. Hirooka, None; M. Saito, None; Y. Yamashita, None; Y. Hashimoto, None; N. Terao, None; H. Koizumi, None; K. Noda, None; S. Ishida, None.

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Corresponding Author: Michiyuki Saito

Supplementary Information

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10384_2021_889_MOESM1_ESM.tif

Supplemental Figure 1. Schema Showing the Pathology of Pachychoroid as Choroidal Congestion and Hyperperfusion. The faucet represents the choroidal artery, the drainage hole represents the vortex vein, and the water in the bathtub represents the total lumen of the choroidal vasculature. (a) Normal choroid: Water is flowing into a bathtub with an open hole, and the amount of water in this bathtub is in equilibrium with a good balance between inflow and outflow. (b) Uncomplicated pachychoroid: When the drainage hole is narrowed (congestion), the balance between inflow and drainage is lost and the water level rises (choroidal vessel dilation followed by choroidal thickening), and due to the increased hydrostatic pressure, a new equilibrium state is achieved at the elevated water level as the disturbed outflow catches up to inflow. (c) The pathogenesis of CSC: When the faucet is potently opens to increase the amount of inflowing water (hyperperfusion), the balance between inflow and drainage is further lost, the water level rises beyond the capacity of the bathtub showing overflow (choroidal vascular hyperpermeability followed by subretinal fluid accumulation) (TIF 254 kb)

Supplementary file2 (TIF 358 kb)

Supplementary file3 (TIF 498 kb)

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Hirooka, K., Saito, M., Yamashita, Y. et al. Imbalanced choroidal circulation in eyes with asymmetric dilated vortex vein. Jpn J Ophthalmol 66, 14–18 (2022). https://doi.org/10.1007/s10384-021-00889-7

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  • DOI: https://doi.org/10.1007/s10384-021-00889-7

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