Abstract
BackgroundTo investigate the diagnostic value of choroidal thickness in the definition of pachychoroid neovasculopathy (PNV), especially in eyes treated with anti-vascular endothelial growth factor (VEGF) therapy.MethodsTwenty-two consecutive eyes of 11 patients with uni- or bilateral PNV were analyzed. Anti-VEGF treatment was correlated with changes in choroidal thickness on enhanced depth imaging optical coherence tomography.ResultsThere were 14 eyes with PNV and 8 non-neovascular partner eyes. Mean age was 64.2 ± 4.0 (range: 60–72), total follow-up was 1.8 ± 0.4 (1–2) years. In PNV eyes, choroidal thickness at baseline was 400 ± 58 (269–485) μm. After two years and 13 anti-VEGF injections on average, a mean reduction of − 39 ± 10 (− 26 to − 56) % to final 241 ± 52 (162–327) μm was observed (p < 0.0001). Meanwhile, choroidal thickness in the partner eyes remained stable (p > 0.13 for all comparisons). A significant correlation of choroidal thinning and anti-VEGF injection rate was observed at year one (r = − 0.79; R2 = 0.63; p = 0.00073) and two (r = − 0.69; R2 = 0.48; p = 0.019). While 85.7% of PNV eyes exceeded a pachychoroid threshold of ≥350 μm at baseline, this figure dropped to 21.4% at year one and 0% at year two.ConclusionIn PNV, choroidal thickness significantly decreases with anti-VEGF therapy, resembling a “vanishing pachy-choroid”, and thus does not represent a valid long-term diagnostic criterium, especially when differentiating PNV from nAMD.
Highlights
To investigate the diagnostic value of choroidal thickness in the definition of pachychoroid neovasculopathy (PNV), especially in eyes treated with anti-vascular endothelial growth factor (VEGF) therapy
What is new: In PNV, choroidal thickness decreases with increasing amounts of antiVEGF injections
We have recently suggested the use of the term PNV as a general term for both PNV and central serous chorioretinopathy (CSC) complicated by choroidal neovascularization (CNV) to facilitate the distinction of neovascular pachychoroid disorders from non-neovacular (CSC, pachychoroid pigment epitheliopathy (PPE)) and neovascular pachychoroid disease with an aneurysmal phenotype [6]
Summary
To investigate the diagnostic value of choroidal thickness in the definition of pachychoroid neovasculopathy (PNV), especially in eyes treated with anti-vascular endothelial growth factor (VEGF) therapy. Pachychoroid disorders of the macula are frequently complicated by a choroidal neovascularization (CNV) [1,2,3]. These include central serous chorioretinopathy (CSC), which can develop secondary CNV in up to 25% of cases [1, 3], and pachychoroid neovasculopathy. We have recently suggested the use of the term PNV as a general term for both PNV and CSC complicated by CNV to facilitate the distinction of neovascular pachychoroid disorders from non-neovacular (CSC, pachychoroid pigment epitheliopathy (PPE)) and neovascular pachychoroid disease with an aneurysmal phenotype (polypoidal choroidal vasculopathy/or aneurysmal type 1 CNV) [6]. PNV is often mistaken as, sometimes unresponsive, neovascular age-related macular degeneration (nAMD) [7], which can be aggravated by the CNV-induced disruption of retinochoroidal tissue, especially if the CNV is mimicking drusenoid pigment epithelium detachments [8]
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