Abstract
PurposeTo evaluate the validity of the novel and noninvasive retro-mode imaging modality of confocal scanning laser ophthalmoscopy (cSLO) for detecting the morphological features of polypoidal choroidal vasculopathy (PCV).DesignProspective, observational, consecutive case series.MethodsTwenty-six patients (29 eyes) with PCV were enrolled in this study. All patients underwent comprehensive ophthalmologic examinations and imaging studies, including retro-mode imaging, fundus autofluorescence (FAF), fundus photography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and spectral-domain optical coherence tomography (SD-OCT). We investigated the retro-mode images and compared the results with those of SD-OCT, FFA and ICGA.ResultsIn the 29 PCV eyes, the retro-mode images clearly revealed polypoidal lesions in 27 (93.1%) eyes as well as branching vascular networks in 16 (55.2%) eyes. Others findings, including pigment epithelial detachment (PED) in 20 (69.0%) eyes, neuroretinal detachment (NRD) in 3 (10.3%) eyes, cystoid macular edema (CME) in 3 (10.3%) eyes, drusen in 4 (13.8%) eyes and minute granular changes of the retinal pigment epithelium (RPE) in 12 (41.3%) eyes, were also clearly visualized. When we compared the results with those of SD-OCT, FFA and ICGA, there was no significant difference between ICGA and retro-mode imaging for finding polypoidal lesions and (or) branching choroidal vascular networks (P>0.05). However, the rate of PED detection was significantly better with retro-mode imaging than with the ICGA (P<0.05). The differences were not statistically significant between SD-OCT and retro-mode imaging for detecting PED, NRD, CME, drusen and minute granular RPE changes (P>0.05). The differences were not statistically significant between FFA and retro-mode imaging for detecting PED, NRD, CME (P>0.05).ConclusionsThe novel and noninvasive retro-mode imaging by cSLO is able to clearly visualize the morphological features of PCV.
Highlights
Polypoidal choroidal vasculopathy (PCV) is a specific form of choroidal vasculopathy associated with multiple, recurrent serosanguineous detachments of the retinal pigment epithelium (RPE) and neurosensory retina [1,2]
The most effective way to establish a definitive diagnosis of PCV is through indocyanine green angiography (ICGA); the diagnosis of PVC is mainly based on the presence of branching choroidal vascular networks with polyp-like terminal aneurysmal dilations or scattered polypoidal dilations without identifiable continuous branching vascular networks in ICGA [3,4]
We used ICGA to make a definitive diagnosis of PCV in each patient; this diagnosis was based on the presence of polypoidal lesions with or without branching vascular networks in ICGA that are characteristics of the disease [3,18]
Summary
Polypoidal choroidal vasculopathy (PCV) is a specific form of choroidal vasculopathy associated with multiple, recurrent serosanguineous detachments of the retinal pigment epithelium (RPE) and neurosensory retina [1,2]. Conventional ICGA is an invasive imaging modality. It requires the injection of intravenous dye and a long capture time. Previous studies based on SD-OCT have demonstrated morphologic abnormalities surrounding the polypoidal lesions [7,8] in most PCV cases, such as pigment epithelial detachment (PED) and protruding or irregular RPE. SD-OCT has some limitations regarding the detection of the entire polypoidal lesion and branching choroidal vascular network underlying the RPE and all of the PCV-related abnormalities of the RPE in the posterior fundus pole. Fundus autofluorescence (FAF), another noninvasive imaging modality, provides topographic information about the metabolic activity of the RPE [11]. FAF does not provide detailed information about the anatomic abnormalities of the choroidal vascular and RPE. Specific protocols for scanning the entire macula and showing the whole PCV lesions are still required
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