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Analysis of choroidal thickness and vascularity in patients with unilateral polypoidal choroidal vasculopathy

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Abstract

Purpose

This study aimed to analyze the choroidal characteristics in eyes with polypoidal choroidal vasculopathy (PCV, affected eyes) and unaffected fellow eyes, and investigated the longitudinal changes in the choroidal structure of fellow eyes in patients with unilateral PCV.

Methods

We retrospectively reviewed the medical records of 55 treatment-naïve patients with unilateral PCV. The choroidal thickness and vascularity between PCV affected eyes, unaffected fellow eyes, and normal control eyes were compared. Structural changes in the choroid of the fellow eyes were reviewed during follow-up.

Results

PCV eyes had thicker subfoveal choroidal thickness (SFCT) (p < 0.001), greater ratio of Haller layer to SFCT (p < 0.001), and lower choroidal vascularity index (p = 0.023), compared to controls. In unaffected fellow eyes, the ratio of the Haller layer to SFCT was greater (p < 0.001) than in controls. During a 58.91-month mean follow-up, nine (16%) fellow eyes developed new PCV. These eyes showed a greater ratio of Haller layer to SFCT at baseline (p < 0.001) compared to the other fellow eyes. We also observed a numerical change in the choroidal vascularity index during follow-up of fellow eyes that developed new PCV.

Conclusion

The dilation of the Haller layer was prominent in PCV eyes and fellow eyes, compared to normal controls. In the fellow eyes that developed new PCV lesions, there were changes in the choroidal vascularity during follow-up.

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References

  1. Yannuzzi LA, Sorenson J, Spaide RF, Lipson B (1990) Idiopathic polypoidal choroidal vasculopathy (IPCV). Retina 10:1–8

    Article  CAS  Google Scholar 

  2. Laude A, Cackett PD, Vithana EN, Yeo IY, Wong D, Koh AH, Wong TY, Aung T (2010) Polypoidal choroidal vasculopathy and neovascular age-related macular degeneration: same or different disease? Prog Retin Eye Res 29:19–29. https://doi.org/10.1016/j.preteyeres.2009.10.001

    Article  PubMed  Google Scholar 

  3. Spaide RF, Yannuzzi LA, Slakter JS, Sorenson J, Orlach DA (1995) Indocyanine green videoangiography of idiopathic polypoidal choroidal vasculopathy. Retina 15:100–110

    Article  CAS  Google Scholar 

  4. Uyama M, Matsubara T, Fukushima I, Matsunaga H, Iwashita K, Nagai Y, Takahashi K (1999) Idiopathic polypoidal choroidal vasculopathy in Japanese patients. Arch Ophthalmol 117:1035–1042

    Article  CAS  Google Scholar 

  5. Sasahara M, Tsujikawa A, Musashi K, Gotoh N, Otani A, Mandai M, Yoshimura N (2006) Polypoidal choroidal vasculopathy with choroidal vascular hyperpermeability. Am J Ophthalmol 142:601–607. https://doi.org/10.1016/j.ajo.2006.05.051

    Article  PubMed  Google Scholar 

  6. Guyer DR, Yannuzzi LA, Slakter JS, Sorenson JA, Hope-Ross M, Orlock DR (1994) Digital indocyanine-green videoangiography of occult choroidal neovascularization. Ophthalmology 101:1727–1735 discussion 1735-1727

    Article  CAS  Google Scholar 

  7. Spaide RF, Koizumi H, Pozzoni MC (2008) Enhanced depth imaging spectral-domain optical coherence tomography. Am J Ophthalmol 146:496–500. https://doi.org/10.1016/j.ajo.2008.05.032

    Article  PubMed  Google Scholar 

  8. Margolis R, Spaide RF (2009) A pilot study of enhanced depth imaging optical coherence tomography of the choroid in normal eyes. Am J Ophthalmol 147:811–815. https://doi.org/10.1016/j.ajo.2008.12.008

    Article  PubMed  Google Scholar 

  9. Koizumi H, Yamagishi T, Yamazaki T, Kawasaki R, Kinoshita S (2011) Subfoveal choroidal thickness in typical age-related macular degeneration and polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 249:1123–1128. https://doi.org/10.1007/s00417-011-1620-1

    Article  PubMed  Google Scholar 

  10. Chung SE, Kang SW, Lee JH, Kim YT (2011) Choroidal thickness in polypoidal choroidal vasculopathy and exudative age-related macular degeneration. Ophthalmology 118:840–845. https://doi.org/10.1016/j.ophtha.2010.09.012

    Article  PubMed  Google Scholar 

  11. Kim SW, Oh J, Kwon SS, Yoo J, Huh K (2011) Comparison of choroidal thickness among patients with healthy eyes, early age-related maculopathy, neovascular age-related macular degeneration, central serous chorioretinopathy, and polypoidal choroidal vasculopathy. Retina 31:1904–1911. https://doi.org/10.1097/IAE.0b013e31821801c5

    Article  PubMed  Google Scholar 

  12. Kuroiwa S, Tateiwa H, Hisatomi T, Ishibashi T, Yoshimura N (2004) Pathological features of surgically excised polypoidal choroidal vasculopathy membranes. Clin Exp Ophthalmol 32:297–302. https://doi.org/10.1111/j.1442-9071.2004.00827.x

    Article  PubMed  Google Scholar 

  13. Cheung CMG, Lee WK, Koizumi H, Dansingani K, Lai TYY, Freund KB (2019) Pachychoroid disease. Eye (Lond) 33:14–33. https://doi.org/10.1038/s41433-018-0158-4

    Article  Google Scholar 

  14. Sonoda S, Sakamoto T, Yamashita T, Shirasawa M, Uchino E, Terasaki H, Tomita M (2014) Choroidal structure in normal eyes and after photodynamic therapy determined by binarization of optical coherence tomographic images. Invest Ophthalmol Vis Sci 55:3893–3899. https://doi.org/10.1167/iovs.14-14447

    Article  PubMed  Google Scholar 

  15. Agrawal R, Salman M, Tan KA, Karampelas M, Sim DA, Keane PA, Pavesio C (2016) Choroidal vascularity index (CVI)—a novel optical coherence tomography parameter for monitoring patients with panuveitis? PLoS One 11:e0146344. https://doi.org/10.1371/journal.pone.0146344

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Agrawal R, Gupta P, Tan KA, Cheung CM, Wong TY, Cheng CY (2016) Choroidal vascularity index as a measure of vascular status of the choroid: measurements in healthy eyes from a population-based study. Sci Rep 6:21090. https://doi.org/10.1038/srep21090

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Wei X, Ting DSW, Ng WY, Khandelwal N, Agrawal R, Cheung CMG (2017) Choroidal vascularity index: a novel optical coherence tomography based parameter in patients with exudative age-related macular degeneration. Retina 37:1120–1125. https://doi.org/10.1097/IAE.0000000000001312

    Article  PubMed  Google Scholar 

  18. Byeon SH, Lee SC, Oh HS, Kim SS, Koh HJ, Kwon OW (2008) Incidence and clinical patterns of polypoidal choroidal vasculopathy in Korean patients. Jpn J Ophthalmol 52:57–62. https://doi.org/10.1007/s10384-007-0498-2

    Article  PubMed  Google Scholar 

  19. Maruko I, Iida T, Saito M, Nagayama D, Saito K (2007) Clinical characteristics of exudative age-related macular degeneration in Japanese patients. Am J Ophthalmol 144:15–22. https://doi.org/10.1016/j.ajo.2007.03.047

    Article  PubMed  Google Scholar 

  20. Sho K, Takahashi K, Yamada H, Wada M, Nagai Y, Otsuji T, Nishikawa M, Mitsuma Y, Yamazaki Y, Matsumura M, Uyama M (2003) Polypoidal choroidal vasculopathy: incidence, demographic features, and clinical characteristics. Arch Ophthalmol 121:1392–1396. https://doi.org/10.1001/archopht.121.10.1392

    Article  PubMed  Google Scholar 

  21. Yang LH, Jonas JB, Wei WB (2013) Optical coherence tomographic enhanced depth imaging of polypoidal choroidal vasculopathy. Retina 33:1584–1589. https://doi.org/10.1097/IAE.0b013e318285cbb3

    Article  PubMed  Google Scholar 

  22. Lafaut BA, Aisenbrey S, Van den Broecke C, Bartz-Schmidt KU, Heimann K (2000) Polypoidal choroidal vasculopathy pattern in age-related macular degeneration: a clinicopathologic correlation. Retina 20:650–654

    CAS  PubMed  Google Scholar 

  23. Rosa RH Jr, Davis JL, Eifrig CW (2002) Clinicopathologic reports, case reports, and small case series: clinicopathologic correlation of idiopathic polypoidal choroidal vasculopathy. Arch Ophthalmol 120:502–508

    Article  Google Scholar 

  24. Terasaki H, Miyake Y, Suzuki T, Nakamura M, Nagasaka T (2002) Polypoidal choroidal vasculopathy treated with macular translocation: clinical pathological correlation. Br J Ophthalmol 86:321–327. https://doi.org/10.1136/bjo.86.3.321

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Okubo A, Sameshima M, Uemura A, Kanda S, Ohba N (2002) Clinicopathological correlation of polypoidal choroidal vasculopathy revealed by ultrastructural study. Br J Ophthalmol 86:1093–1098. https://doi.org/10.1136/bjo.86.10.1093

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Lee H, Bae K, Kang SW, Woo SJ, Ryoo NK, Kim SJ, Han G (2016) Morphologic characteristics of choroid in the major choroidal thickening diseases, studied by optical coherence tomography. PLoS One 11:e0147139. https://doi.org/10.1371/journal.pone.0147139

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Takahashi Y, Koizumi H, Hasegawa T, Izumi T, Maruko I, Sonoda S, Sakamoto T, Iida T (2018) Comparison of subfoveal choroidal structures in typical neovascular age-related macular degeneration and polypoidal choroidal vasculopathy. Jpn J Ophthalmol 62:576–583. https://doi.org/10.1007/s10384-018-0615-4

    Article  CAS  PubMed  Google Scholar 

  28. Nickla DL, Wallman J (2010) The multifunctional choroid. Prog Retin Eye Res 29:144–168. https://doi.org/10.1016/j.preteyeres.2009.12.002

    Article  PubMed  Google Scholar 

  29. Bakthavatsalam M, Ng DS, Lai FH, Tang FY, Brelen ME, Tsang CW, Lai TY, Cheung CY (2017) Choroidal structures in polypoidal choroidal vasculopathy, neovascular age-related maculopathy, and healthy eyes determined by binarization of swept source optical coherence tomographic images. Graefes Arch Clin Exp Ophthalmol 255:935–943. https://doi.org/10.1007/s00417-017-3591-3

    Article  PubMed  Google Scholar 

  30. McLeod DS, Taomoto M, Otsuji T, Green WR, Sunness JS, Lutty GA (2002) Quantifying changes in RPE and choroidal vasculature in eyes with age-related macular degeneration. Invest Ophthalmol Vis Sci 43:1986–1993

    PubMed  Google Scholar 

  31. Mullins RF, Johnson MN, Faidley EA, Skeie JM, Huang J (2011) Choriocapillaris vascular dropout related to density of drusen in human eyes with early age-related macular degeneration. Invest Ophthalmol Vis Sci 52:1606–1612. https://doi.org/10.1167/iovs.10-6476

    Article  PubMed  PubMed Central  Google Scholar 

  32. Seddon JM, McLeod DS, Bhutto IA, Villalonga MB, Silver RE, Wenick AS, Edwards MM, Lutty GA (2016) Histopathological insights into choroidal vascular loss in clinically documented cases of age-related macular degeneration. JAMA Ophthalmol 134:1272–1280. https://doi.org/10.1001/jamaophthalmol.2016.3519

    Article  PubMed  PubMed Central  Google Scholar 

  33. Jirarattanasopa P, Ooto S, Nakata I, Tsujikawa A, Yamashiro K, Oishi A, Yoshimura N (2012) Choroidal thickness, vascular hyperpermeability, and complement factor H in age-related macular degeneration and polypoidal choroidal vasculopathy. Invest Ophthalmol Vis Sci 53:3663–3672. https://doi.org/10.1167/iovs.12-9619

    Article  CAS  PubMed  Google Scholar 

  34. Adhi M, Ferrara D, Mullins RF, Baumal CR, Mohler KJ, Kraus MF, Liu J, Badaro E, Alasil T, Hornegger J, Fujimoto JG, Duker JS, Waheed NK (2015) Characterization of choroidal layers in normal aging eyes using enface swept-source optical coherence tomography. PLoS One 10:e0133080. https://doi.org/10.1371/journal.pone.0133080

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Dansingani KK, Balaratnasingam C, Naysan J, Freund KB (2016) En face imaging of pachychoroid spectrum disorders with swept-source optical coherence tomography. Retina 36:499–516. https://doi.org/10.1097/IAE.0000000000000742

    Article  PubMed  Google Scholar 

  36. Lee WK, Baek J, Dansingani KK, Lee JH, Freund KB (2016) Choroidal morphology in eyes with polypoidal choroidal vasculopathy and normal or subnormal subfoveal choroidal thickness. Retina 36(Suppl 1):S73–S82. https://doi.org/10.1097/IAE.0000000000001346

    Article  PubMed  Google Scholar 

  37. Baek J, Dansingani KK, Lee JH, Lee WK, Freund KB (2019) Choroidal morphology in eyes with peripapillary polypoidal choroidal vasculopathy. Retina 39:1571–1579. https://doi.org/10.1097/IAE.0000000000002188

    Article  PubMed  Google Scholar 

  38. Yanagi Y, Mohla A, Lee WK, Lee SY, Mathur R, Chan CM, Yeo I, Wong TY, Cheung CMG (2017) Prevalence and risk factors for nonexudative neovascularization in fellow eyes of patients with unilateral age-related macular degeneration and polypoidal choroidal vasculopathy. Invest Ophthalmol Vis Sci 58:3488–3495. https://doi.org/10.1167/iovs.16-21167

    Article  PubMed  Google Scholar 

  39. Balaratnasingam C, Lee WK, Koizumi H, Dansingani K, Inoue M, Freund KB (2016) Polypoidal choroidal vasculopathy: a distinct disease or manifestation of many? Retina 36:1–8. https://doi.org/10.1097/IAE.0000000000000774

    Article  PubMed  Google Scholar 

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Funding

This study was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Education (2016R1A6A1A03010528).

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Correspondence to Young-Hoon Park.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Lee, K., Park, JH., Park, Y.G. et al. Analysis of choroidal thickness and vascularity in patients with unilateral polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 258, 1157–1164 (2020). https://doi.org/10.1007/s00417-020-04620-z

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  • DOI: https://doi.org/10.1007/s00417-020-04620-z

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