Abstract
Polypoidal choroidal vasculopathy (PCV) is a common choroidal vascular disease particularly in Asians. However, the underlying pathogenesis of PCV is still yet to be fully elucidated, and the correlation between choroidal vasculature and treatment response of PCV are poorly understood. Accordingly, we sought to find clues to understand the pathogenesis and prognosis of PCV by quantitatively evaluating choroidal vasculature from the entire fundus using ultra-widefield (UWF) indocyanine green angiography (ICGA). In this study, 32 eyes from 29 patients with treatment naïve PCV and 30 eyes from 30 healthy control participants were enrolled. Choroidal vascular density (CVD) of PCV eyes was higher than normal eyes in majority regions including the periphery. CVD was positively correlated with choroidal thickness and choroidal hyperpermeability, supporting that the pathogenesis of PCV may include choroidal congestion and dilatation. Thicker choroid and higher CVD were also correlated with poor treatment response after anti-VEGF injections. The CVD, quantified from UWF ICGA can also be used as an effective image biomarker to predict the treatment response in PCV.
Highlights
Polypoidal choroidal vasculopathy (PCV) is a common choroidal vascular disease in Asians
The findings of previous studies were mostly based on cross-sectional images of enhanced depth imaging (EDI) or en face optical coherence tomography (OCT), which demonstrate only limited field-of-view
Chung et al demonstrated the association between engorgement of the vortex vein and the development of PCV using a montage of images taken by conventional indocyanine green angiography (ICGA) with a confocal laser scanning system[22]
Summary
Polypoidal choroidal vasculopathy (PCV) is a common choroidal vascular disease in Asians. We sought to find clues to understand the pathogenesis and prognosis of PCV by quantitatively evaluating choroidal vasculature from the entire fundus using ultra-widefield (UWF) indocyanine green angiography (ICGA). Evaluation of the choroid in PCV has important value in predicting the prognosis of treatment response and supporting disease pathogenesis in addition to presenting the clinical and imaging features of the disease. The study was the first to report the choroidal vascular features of PCV from the extended area, quantitative analysis of choroidal vasculature was not available since the montage image does not permit simultaneous imaging of the posterior pole and periphery. We sought to evaluate the precise area and density of choroidal vasculature using UWF ICGA over the whole fundus and in each prespecified region in the PCV patients. We evaluated the relationship between the choroidal vascular density (CVD) with baseline characteristics, including clinical
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