Diagnosis Of Polypoidal Choroidal Vasculopathy Research Articles

Diagnosing Polypoidal Choroidal Vasculopathy using Color Fundus Photography, Optical Coherence Tomography and Optical Coherence Tomography Angiography.

To compare the diagnostic accuracy of differentiating polypoidal choroidal vasculopathy (PCV) from exudative age-related macular degeneration (AMD), using color fundus photography (CFP), optical coherence tomography (OCT), and swept-source optical coherence tomography angiography (SS-OCTA) without using fluorescein angiography/ indocyanine green angiography (FA/ICGA). Treatment-naïve eyes with exudative age-related macular degeneration (AMD) that underwent CFP, OCT, SS-OCTA, and FA/ICGA imaging before treatment were identified. Images of each patient were categorized into 2 sets (Set A: CFP+OCT; Set B: CFP+ SS-OCTA). In Set B, both the en face and cross-sectional B-scans were analyzed. Each set was reviewed by two graders, and it was determined whether the presumed diagnosis was PCV. Sensitivity, specificity, and area under the curve (AUC) for the diagnosis of PCV were assessed for each set by comparing diagnoses that included ICGA. The number of polypoidal lesions in each set was calculated and compared to ICGA. A total of 94 study eyes from 94 patients with AMD were included in the study, of which 66.0% were male, and the mean age was 71.8±9.0 years. The PCV diagnosis rate using ICGA was 45.7%. Sensitivity of sets A, B: 0.88, 0.93; specificity: 0.94, 0.96; positive predictive value: 0.93, 0.95; negative predictive value: 0.91, 0.94, AUC: 0.90 (95% confidence interval [CI]:0.83-0.97), 0.96 (95% CI:0.90-1.00). Set A detected polypoidal lesions 1.28±0.91, Set B detected polypoidal lesions 1.47±1.01, ICGA showed 1.51±0.86. In the interclass correlation coefficient analysis, the correlation between Set A and ICGA was ICC=0.76(95% CI:0.60-0.86, p<0.001), and the correlation between Set B and ICGA was ICC=0.84(95% CI:0.72-0.91, p<0.001). This study highlights that, without using ICGA, both CFP combined with OCT and CFP combined with SS-OCTA demonstrate high sensitivity, specificity, and AUC in diagnosing PCV. It is evident that SS-OCTA contributes to enhancing sensitivity, specificity, and AUC for PCV diagnosis.

Recent Advances in Imaging Polypoidal Choroidal Vasculopathy with Swept-Source Optical Coherence Tomography Angiography.

The gold standard for polypoidal choroidal vasculopathy (PCV) diagnosis is indocyanine green angiography (ICGA), but optical coherence tomography angiography (OCTA) has shown promise for PCV imaging in recent years. However, earlier generations of OCTA technology lacked the diagnostic efficacy to replace ICGA. Swept-source optical coherence tomography angiography (SS-OCTA), the latest generation of OCTA technology, has significantly improved penetrating ability, scanning speed, scanning range, and overall image quality compared with earlier generations of OCTA. SS-OCTA reveals a "tangled vasculature" pattern of polypoidal lesions (PLs), providing evidence that they are neovascular rather than aneurysmal structures. New choroidal biomarkers, such as the choriocapillaris flow void (FV), have been identified to explain the development of PCV lesions. Although no direct comparison between SS-OCTA and previous OCTA generations in terms of diagnostic capability has been performed, SS-OCTA has shown several advantages in differential diagnosis and monitoring early reactivation for PCV. These improvements make SS-OCTA a valuable tool for PCV diagnosis and follow-up, and it may become more important for this disease in the future. This review summarized recent advances in PCV morphology and structure, as well as the possible pathogenesis based on SS-OCTA findings. The value of SS-OCTA for PCV management is discussed, along with remaining issues, to provide an updated understanding of PCV and OCTA-guided management.

New Concepts for the Diagnosis of Polypoidal Choroidal Vasculopathy.

Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular age-related macular degeneration (nAMD) that is characterized by a branching neovascular network and polypoidal lesions. It is important to differentiate PCV from typical nAMD as there are differences in treatment response between subtypes. Indocyanine green angiography (ICGA) is the gold standard for diagnosing PCV; however, ICGA is an invasive detection method and impractical for extensive use for regular long-term monitoring. In addition, access to ICGA may be limited in some settings. The purpose of this review is to summarize the utilization of multimodal imaging modalities (color fundus photography, optical coherence tomography (OCT), OCT angiography (OCTA), and fundus autofluorescence (FAF)) in differentiating PCV from typical nAMD and predicting disease activity and prognosis. In particular, OCT shows tremendous potential in diagnosing PCV. Characteristics such as subretinal pigment epithelium (RPE) ring-like lesion, en face OCT-complex RPE elevation, and sharp-peaked pigment epithelial detachment provide high sensitivity and specificity for differentiating PCV from nAMD. With the use of more practical, non-ICGA imaging modalities, the diagnosis of PCV can be more easily made and treatment tailored as necessary for optimal outcomes.

Polypoidal Choroidal Vasculopathy: Updates on Risk Factors, Diagnosis, and Treatments.

There have been recent advances in basic research and clinical studies in polypoidal choroidal vasculopathy (PCV). A recent, large-scale, population-based study found systemic factors, such as male gender and smoking, were associated with PCV, and a recent systematic review reported plasma C-reactive protein, a systemic biomarker, was associated with PCV. Growing evidence points to an association between pachydrusen, recently proposed extracellular deposits associated with the thick choroid, and the risk of development of PCV. Many recent studies on diagnosis of PCV have focused on applying criteria from noninvasive multimodal retinal imaging without requirement of indocyanine green angiography. There have been attempts to develop deep learning models, a recent subset of artificial intelligence, for detecting PCV from different types of retinal imaging modality. Some of these deep learning models were found to have high performance when they were trained and tested on color retinal images with corresponding images from optical coherence tomography. The treatment of PCV is either a combination therapy using verteporfin photodynamic therapy and anti-vascular endothelial growth factor (VEGF), or anti-VEGF monotherapy, often used with a treat-and-extend regimen. New anti-VEGF agents may provide more durable treatment with similar efficacy, compared with existing anti-VEGF agents. It is not known if they can induce greater closure of polypoidal lesions, in which case, combination therapy may still be a mainstay. Recent evidence supports long-term follow-up of patients with PCV after treatment for early detection of recurrence, particularly in patients with incomplete closure of polypoidal lesions.

Prevalence of Polypoidal Choroidal Vasculopathy in Eyes with Neovascular Age-Related Macular Degeneration Resistant to Intravitreal Anti-VEGF Treatment.

To determine the prevalence of polypoidal choroidal vasculopathy (PCV) in intravitreal (IV) anti-vascular endothelial growth factor (anti-VEGF)-resistant neovascular age-related macular degeneration (nvAMD) cases. Eyes that were diagnosed as having active and treatment-naive nvAMD in the Ege University Ophthalmology Department, Retina Unit in 2011-2018, were non-responsive to IV anti-VEGF treatment, and for which indocyanine angiography (ICGA) could be obtained were included in the study. Active nvAMD was defined as the presence of fresh hemorrhage on clinical examination or findings of subretinal, intraretinal, or sub-retinal pigment epithelial fluid on spectral domain optical coherence tomography and accompanying fluorescein dye leakage in fluorescein angiography. Eyes that had activation findings despite at least 6 consecutive intravitreal anti-VEGF injections were defined as non-responders and underwent ICGA to assess for PCV. The diagnosis of PCV was based on the Everest II study criterion. A total of 97 eyes of 88 patients were included in the study. Of 88 patients, 44 (50%) were female, 44 (50%) were male, and the mean age was 75.9±8.3 years (range: 59-93). The mean number of anti-VEGF injections until the time of ICGA was 7.3±2.2 (range: 6-15). PCV was detected in 62 eyes (63.9%) on ICGA. The prevalence of PCV is quite high among eyes with IV anti-VEGF treatment-resistant nvAMD in Turkey (63.9%). ICGA evaluation for PCV should be conducted for all nvAMD cases that are non-responsive to IV anti-VEGF treatment, both to shed light on the reason for resistance and to modify treatment as necessary.

Current Trends in Clinical Characteristics, Diagnosis, and Treatment of Polypoidal Choroidal Vasculopathy: A Perspective from Vietnam.

Polypoidal choroidal vasculopathy (PCV) is a common choroidal disease in the Asian population including Vietnam and is characterized by subretinal red-orange nodules, pigmented epithelium detachment, and massive subretinal hemorrhage. The recent focus on PCV in Vietnam can be attributed to advancements in PCV diagnosis and treatment. However, there is a scarcity of published literature and clinical data on PCV in the Vietnamese population, highlighting a key knowledge gap in this region. In order to address this gap, we gathered the opinions of experienced clinicians and retinal experts in Vietnam and reviewed available medical literature with the aim of: (i) providing an overview of PCV in the Vietnamese population—in terms of epidemiology, clinical characteristics, and management; (ii) tailoring international/national guidelines for the diagnosis and management of PCV, in line with available resources and medical equipment in Vietnam; and (iii) identifying gaps in clinical data in order to guide future PCV research in Vietnam and other countries with similar clinical conditions. The present review will enable healthcare providers and researchers to gain insight into current clinical practices and the limitations of PCV management in Vietnam and provide optimal and effective solutions.

Analysis of the aqueous humor lipid profile in patients with polypoidal choroidal vasculopathy

This study aimed to investigate the lipid profiles of aqueous humor from polypoidal choroidal vasculopathy (PCV) patients and identify potential biomarkers to increase the understanding of PCV pathomechanism. An ultra-high performance liquid chromatography-tandem mass spectrometry based untargeted lipidomic analysis was performed to acquire lipid profiles of aqueous humor of PCV patients and control subjects. Differentially expressed lipids were identified by univariate and multivariate analyses. A receiver operator characteristic curve (ROC) analysis was conducted to confirm the potential of identified lipids as biomarkers. Sixteen PCV patients and twenty-eight control subjects were enrolled in this study. In total, we identified 33 lipid classes and 639 lipid species in aqueous humor using the LipidSearch software. Of them, 50 differential lipids were obtained by combining univariate and multivariate statistical analyses (VIP>1 and P < 0.05), and 19 potential lipid biomarkers were identified by ROC analysis. In addition, significant alterations were found in several metabolic pathways, including glycerophospholipid, glycerolipid, and glycosylphosphatidylinositol-anchor biosynthesis. This study is the first to systematically characterize the alterations in lipid profiles in aqueous humor of PCV patients and screen for the potential lipid biomarkers for PCV diagnosis and treatment intervention. The results of this study are likely to broaden our understanding of the pathogenesis of PCV and contribute to improvements in the diagnosis and treatment of the disease.

Clinical explainable differential diagnosis of polypoidal choroidal vasculopathy and age-related macular degeneration using deep learning

BackgroundThis study aims to achieve an automatic differential diagnosis between two types of retinal pathologies with similar pathological features - Polypoidal choroidal vasculopathy (PCV) and wet age-related macular degeneration (AMD) from volumetric optical coherence tomography (OCT) images, and identify clinically-relevant pathological features, using an explainable deep-learning-based framework. MethodsThis is a retrospective study with data from a cross-sectional cohort. The OCT volume of 73 eyes from 59 patients was included in this study. Disease differentiation was achieved through single-B-scan-based classification followed by a volumetric probability prediction aggregation step. We compared different labeling strategies with and without identifying pathological B-scans within each OCT volume. Clinical interpretability was achieved through normalized aggregation of B-scan-based saliency maps followed by maximum-intensity-projection onto the en face plane. We derived the PCV score from the proposed differential diagnosis framework with different labeling strategies. The en face projection of saliency map was validated with the pathologies identified in Indocyanine green angiography (ICGA). ResultsModel trained with both labeling strategies achieved similar level differentiation power (>90%), with good correspondence between pathological features detected from the projected en face saliency map and ICGA. ConclusionsThis study demonstrated the potential clinical application of non-invasive differential diagnosis using AI-driven OCT-based analysis, with minimal requirement of labeling efforts, along with clinical explainability achieved through automatically detected disease-related pathologies.

Diagnosis of Polypoidal Choroidal Vasculopathy From Fluorescein Angiography Using Deep Learning.

PurposeTo differentiate polypoidal choroidal vasculopathy (PCV) from choroidal neovascularization (CNV) and to determine the extent of PCV from fluorescein angiography (FA) using attention-based deep learning networks.MethodsWe build two deep learning networks for diagnosis of PCV using FA, one for detection and one for segmentation. Attention-gated convolutional neural network (AG-CNN) differentiates PCV from other types of wet age-related macular degeneration. Gradient-weighted class activation map (Grad-CAM) is generated to highlight important regions in the image for making the prediction, which offers explainability of the network. Attention-gated recurrent neural network (AG-PCVNet) for spatiotemporal prediction is applied for segmentation of PCV.ResultsAG-CNN is validated with a dataset containing 167 FA sequences of PCV and 70 FA sequences of CNV. AG-CNN achieves a classification accuracy of 82.80% at image-level, and 86.21% at patient-level for PCV. Grad-CAM shows that regions contributing to decision-making have on average 21.91% agreement with pathological regions identified by experts. AG-PCVNet is validated with 56 PCV sequences from the EVEREST-I study and achieves a balanced accuracy of 81.132% and dice score of 0.54.ConclusionsThe developed software provides a means of performing detection and segmentation of PCV on FA images for the first time. This study is a promising step in changing the diagnostic procedure of PCV and therefore improving the detection rate of PCV using FA alone.Translational RelevanceThe developed deep learning system enables early diagnosis of PCV using FA to assist the physician in choosing the best treatment for optimal visual prognosis.

THE ROLE OF AFLIBERCEPT IN THE TREATMENT OF A PATIENT WITH POLYPOIDAL CHOROIDAL VASCULOPATHY - CASE REPORT

&nbsp;To present a patient with polypoidal choroidal vasculopathy, an entity often overlooked and misdiagnosed in daily clinical practice. A 73-year-old patient with reduced visual acuity in the left eye was evaluated with a complete ophthalmological examination, fundus photography, optical coherence tomography of the posterior segment of the eye, and optical coherence tomography with angiography and a diagnosis of polypoidal choroidal vasculopathy with development of a type 1 choroidal neovascular network (aneurysmal-polypoidal network) was made. The changes shown on OCT referred to the presence of subretinal fluid, PED in the shape of the letter M, the presence of a "double layer sign" from the developed neovascular network in the form of a renal glomerulus. After application of an anti-VEGF preparation (Aflibercept) for a period of six months (five applied doses, three consecutive, and two every two months) there was regression of the lesion and improvement of visual acuity from 0.5 to 0.9 according to the Snellen optotype.&nbsp;&nbsp;The characteristic changes of OCT and OCT-A, as well as the course of the disease corresponded with the literature data that we consulted during the evaluation of this case, thus the diagnosis of polypoidal choroidal vasculopathy was confirmed. Timely recognition of this not so rare entity is of great importance for appropriate management and treatment of the affected patient. Keywords: polypoidal choroidal vasculopathy, subretinal fluid, choroidal neovascular membrane, aflibercept

PULSATILE FILLING OF DILATED CHOROIDAL VESSELS IN MACULAR WATERSHED ZONES.

To describe pulsatile filling of dilated choroidal veins in the watershed zones and propose an alteration in choroidal perfusion pressure. Retrospective review of original and digital subtraction indocyanine green angiography. We observed pulsating blood flow within choroidal vein segments in the posterior pole in 14 eyes (diagnosis of polypoidal choroidal vasculopathy, central serous chorioretinopathy, or neovascular age-related macular degeneration). Pulsating dye front was observed in single or multiple large choroidal vein(s) in a location that is ordinarily a watershed zone between the segmental areas of venous drainage, and vessels proximal and distal were often dilated. The pulsatile venous segments filled more slowly than the neighboring veins. In digital subtraction indocyanine green angiography, the dye front advanced in an incremental fashion or oscillated in a back-and-forth manner during several cardiac cycles during the filling of these larger choroidal veins. With indocyanine green angiography, we observed dilated choroidal veins that violated the macula watershed zone, localized bulbous dilations, and arteriole-over-vein crossings with apparent compression. These novel observations suggest the pressure gradient for flow in the affected veins varied from low gradients when the filling was slow to high gradients when the filling was faster. The vessels violated the physiological watershed zone and seem to function as anastomoses between the ordinarily segmented venous drainage of the choroid. The dilated segments may result in pooling of venous blood as part of venous outflow abnormalities that may be operative in these diseases.

Thermal Laser Monotherapy for Extrafoveal Polypoidal Choroidal Vasculopathy

Polypoidal choroidal vasculopathy (PCV) is a vascular disease of the choroid. Diagnosis is mainly based on polypoidal aneurysm-like lesions seen in indocyanine green (ICG) angiography. Various therapeutic options have been proposed. Outcomes of 10 cases with extrafoveal PCV and consecutive macular edema treated with thermal laser are reported. Diagnosis of PCV was confirmed by ICG angiography. Upon successful occlusion of the polyps in 10 eyes after thermal laser treatment demonstrated in ICG angiography, a regression of central foveal edema was seen in optical coherence tomography and color fundus photography. Visual acuity improved from logMAR 0.8 to logMAR 0.3. Follow-up ranged from 4 months to 15 years, with a median of 1 year. Two eyes had a recurrence of exudative maculopathy 5 and 7years after laser treatment, respectively. A careful differentiation between various subforms of exudative maculopathy using fluorescein and ICG angiography can identify certain selected patients with extrafoveal PCV, for whom thermal laser monotherapy can be a therapeutic option.

Comparison of Indocyanine Green Angiography and Optical Coherence Tomography Angiography for Polypoidal Choroidal Vasculopathy

Purpose: To assess the diagnostic value of optical coherence tomography angiography (OCTA), and the factors affecting the diagnosis of polypoidal choroidal vasculopathy (PCV) by OCTA and indocyanine green angiography (ICGA). Methods: The numbers and area of polyps, and the presence and area of a branched vascular network (BVN) as revealed by ICGA and OCTA, were retrospectively analyzed in 43 patients with active PCV. The patients were divided into two groups according to whether the number of polyps matched between the two methods: group 1, equal number of polyps revealed by ICGA and OCTA; group 2, different number of polyps revealed by ICGA and OCTA. Results: In 43 PCV patients, the total number of polyps was 1.47 ± 0.83 in ICGA and 1.07 ± 0.91 in OCTA (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), and the polyp area was 0.27 ± 0.42 mm&lt;sup&gt;2&lt;/sup&gt; in ICGA and 0.17 ± 0.15 mm&lt;sup&gt;2&lt;/sup&gt; in OCTA (&lt;i&gt;p&lt;/i&gt; = 0.023). BVN was found in 33 eyes (76.7%) by ICGA and 29 eyes (67.4%) by OCTA (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). The BVN area was 3.61 ± 2.59 mm&lt;sup&gt;2&lt;/sup&gt; in ICGA and 2.74 ± 2.76 mm&lt;sup&gt;2&lt;/sup&gt; in OCTA (&lt;i&gt;p&lt;/i&gt; = 0.002). Central retinal thickness and central choroidal thickness were significantly greater in group 2 than group 1 (&lt;i&gt;p&lt;/i&gt; &lt; 0.001, respectively). Subretinal fluid (SRF) (&lt;i&gt;p&lt;/i&gt; = 0.009) and subretinal hemorrhage (SRH) (&lt;i&gt;p&lt;/i&gt; = 0.005) were significantly more prevalent in group 2 than group 1. Polyp height (&lt;i&gt;p&lt;/i&gt; = 0.022) and diameter (&lt;i&gt;p&lt;/i&gt; = 0.042) were significantly greater in group 2 than group 1. Conclusions: OCTA is a supplementary diagnostic technique for detecting PCV. The presence of SRF and SHR, and large polyp height and diameter, were associated with the polyp detection rate of OCTA for PCV.

A case of bilateral pachychoroid disease: polypoidal choroidal vasculopathy in one eye and peripheral exudative hemorrhagic chorioretinopathy in contralateral eye

BackgroundWe report a case of bilateral pachychoroid disease manifesting polypoidal choroidal vasculopathy (PCV) with punctate hyperfluorescent spot (PHS) in one eye, and peripheral exudative hemorrhagic choroidal retinopathy (PEHCR) with central serous chorioretinopathy (CSC) and PHS in the contralateral eye.Case presentation: A 51-year-old healthy woman presented with complaint of blurred vision in her right eye. Corrected visual acuity was 20/20 in the right and 24/20 in the left eye. Fundus examination was normal in the left eye. In the right eye, fundus finding of an orange-red nodular lesion and optical coherence tomography (OCT) finding of polypoidal lesions led to a diagnosis of PCV. Four aflibercept intravitreal injections were performed in her right eye. After treatment, indocyanine green angiography (ICGA) confirmed residual polypoidal lesions with branching vascular networks and PHS with choroidal vascular hyperpermeability. OCT showed PHS associated with small sharp-peaked retinal pigment epithelium (RPE) elevation in peripheral fundus and small RPE elevation in posterior fundus. Based on the above findings, PCV with PHS was finally diagnosed in the right eye. Posttreatment corrected visual acuity in the right eye was 20/20. She presented again 32 months later, with complaint of vision loss in her left eye. Left corrected visual acuity was 20/20, and fundus examination showed mild vitreous hemorrhage. Vitrectomy was performed. In temporal midperipheral fundus, fluorescein angiography revealed CSC, and OCT showed pachychoroid. ICGA depicted abnormal choroidal networks and PHS in peripheral fundus. Furthermore, polypoidal lesions were confirmed by OCT. Based on the above findings, PEHCR and CSC with PHS was finally diagnosed in the left eye. Postoperative corrected visual acuity in the left eye was 20/20, and aflibercept intravitreal injection was performed for prevention of recurrence of vitreous hemorrhage.ConclusionsThis is the first case report of PCV with PHS in one eye, and PEHCR with CSC and PHS in the contralateral eye. This case suggests that PCV, PEHCR, and CSC may be linked pathologies of pachychoroid spectrum disease.

THE INCIDENCE, CHARACTERISTICS, MANAGEMENT, PROGNOSIS, AND CLASSIFICATION OF BREAKTHROUGH VITREOUS HEMORRHAGE SECONDARY TO POLYPOIDAL CHOROIDAL VASCULOPATHY.

To describe breakthrough vitreous hemorrhage secondary to polypoidal choroidal vasculopathy (PCV). Patients with the diagnosis of PCV from January 2005 to March 2020 at Peking Union Medical College Hospital were retrospectively reviewed, cases with breakthrough vitreous hemorrhage were analyzed. Subgroup analysis was conducted regarding pachychoroid PCV and nonpachychoroid PCV. Among 722 PCV patients (834 eyes), 103 eyes with breakthrough vitreous hemorrhage (12.4%) were included. Pars plana vitrectomy and proper further interventions could significantly improve the best-corrected visual acuity from logMAR 2.15 ± 0.48 (Snellen 20/2825) to 1.65 ± 0.67 (20/893). Hemorrhagic retinal detachment, baseline central macular thickness, and best-corrected visual acuity were factors associated with final best-corrected visual acuity (P < 0.05). In the pachychoroid PCV group, patients were younger, all had hemorrhagic pigment epithelial detachment, with a higher prevalence of choroidal vascular hyperpermeability and hemorrhagic retinal detachment, thicker subfoveal choroidal thickness, and thinner central macular thickness; besides, the initial pars plana vitrectomy were more complicated, more additional surgeries had to be performed. More eyes in the nonpachychoroid PCV group had received anti-vascular endothelial growth factor or photodynamic therapy, mostly fibrovascular pigment epithelial detachment, the best-corrected visual acuity and the status of the fellow eye were significantly worse. For the final ocular status, more eyes in nonpachychoroid PCV group were taking anti-vascular endothelial growth factor monotherapy, whereas more eyes in pachychoroid PCV group were stable. The choroidal parameters of these two groups were all significantly different. Breakthrough vitreous hemorrhage is a troublesome complication of PCV. Pars plana vitrectomy and additional interventions are required for better prognosis. Vitreous hemorrhage secondary to pachychoroid PCV or nonpachychoroid PCV have different characteristics and prognosis.

Clinical features of pachyvessels associated with polypoidal choroidal vasculopathy in chronic central serous chorioretinopathy

To investigate the association between clinical features of chronic central serous chorioretinopathy (CSC) and subsequent development of polypoidal choroidal vasculopathy (PCV). Characteristics and treatment response of PCV secondary to CSC were described. This retrospective observational study included 18 patients with chronic CSC (18 eyes) with subsequent PCV and 36 controls (36 eyes) with chronic CSC without PCV development during follow-up. Clinical features were compared between the two groups. A logistic regression model was used to evaluate the risk factor of PCV formation. Treatments for PCV included anti-vascular endothelial growth factor (VEGF) monotherapy, photodynamic therapy (PDT), or PDT and anti-VEGF combination treatment. Subretinal fluid on optical coherence tomography images were assessed after treatments. Significant between-group differences were observed in best-corrected visual acuity after disease resolution and presence of pachyvessels (P = .001 and P = .003, respectively). The presence of pachyvessels in chronic CSC was associated with subsequent PCV (odds ratio = 6.00; 95% CI, 1.74–20.68; P = .005). CSC recurrence and subfoveal choroidal thickness (SFCT) were not significantly associated with subsequent PCV development (P = .393 and P = .911, respectively). The mean age of PCV diagnosis was 51 years, and the mean time from CSC diagnosis to PCV confirmation was 77.8 months. The mean (range) SFCT of PCV was 327.7 (134–599) μm. Nine patients received anti-VEGF monotherapy and 5 had disease remission. Four patients received PDT and anti-VEGF combination treatment and all of the 4 had disease remission. In chronic CSC, pachyvessel characteristics are associated with subsequent PCV development. This result will assist clinicians to evaluate CSC in clinical practice and provide insights into the pathogenesis of PCV.

Baseline Optical Coherence Tomography Parameters That May Influence 6 Months Treatment Outcome of Polypoidal Choroidal Vasculopathy Eyes with Combination Therapy: A Short-Term Pilot Study.

Although optical coherence tomography (OCT) parameters have assisted in the diagnosis of polypoidal choroidal vasculopathy (PCV), its potential to evaluate treatment outcomes has not been established. The purpose of this pilot study was to evaluate baseline OCT parameters that may influence treatment outcome in PCV eyes with combination therapy. In this single-centered, prospective study, patients were recruited with at least one treatment-naïve PCV eye and treated with combination therapy of intravitreal anti-vascular endothelial growth factor and photodynamic therapy. Best-corrected distance and near visual acuity (DVA and NVA), and contrast sensitivity (CS) were recorded at baseline and six months after treatment. OCT parameters were determined. Twenty-six eyes of 26 patients aged between 51 to 83 years were evaluated. In eyes that had disrupted external limiting membrane (ELM), photoreceptors inner and outer segment (IS-OS) junction at 1000 micron of fovea at baseline showed low mean visual functions after 6 months of treatment. Eyes with foveal sub-retinal fluid (SRF) and polyp at central 1000 micron of fovea at baseline showed significantly worse DVA and CS after six months. Thus, the presence of foveal SRF, foveal polyp, disrupted ELM, and IS-OS junction at baseline significantly influenced the six months’ visual outcome in PCV eyes treated with combination therapy.

CHOROIDAL VASCULARITY INDICES AND COEXISTING MORPHOLOGICAL CHANGES IN POLYPOIDAL CHOROIDAL VASCULOPATHY. A COMPARATIVE ANALYSIS BETWEEN TWO TREATMENT STRATEGIES

Purpose: Compare the effect of Combination therapy (PDT+Anti-VEGF) and Anti-VEGF monotherapy on choroidal vascularity indices and morphological parameters in Polypoidal Choroidal Vasculopathy (PCV). Methods: Retrospective, cohort study involving 33eyes with a diagnosis of PCV and had visible sclerochoroidal boundary on enhanced depth imaging. Cases were treated either with combination (n=17) or Anti-VEGF monotherapy (n=16). Demographic details, visual acuity assessment, OCT analysis was considered from baseline to the 3rd and 6th month follow-up visits. Choroidal vascularity analysis including choroidal thickness, Total Choroidal Surface Area (TCSA), Total Stromal area (TSA), Total Luminal Area (TLA) and Choroidal Vascularity Index (CVI) assessment were done with ImageJ software using the technique of image binarization. Results: Disease activity was significantly higher in the Anti-VEGF monotherapy arm compared to the combination therapy arm both at 3 and 6 months. When compared to baseline values, there was statistically significant decrease in choroidal thickness, Double layer sign (DLS) width, TCSA, TSA and TLA (P&lt;0.05) in the combination therapy arm. Whereas, Anti-VEGF monotherapy arm showed an increase in the mean sub foveal choroidal thickness and DLS width at both visits. Complete collapse of PED, reduction in DLS width which was achieved only in combination therapy arm showed significant positive correlation with the resolution of the disease. CVI did not show a statistically significant reduction in both the arms. Conclusion: In view of better outer retinal and choroidal morphological changes and vascular remodelling, our study strongly supports the superiority of combination therapy over Anti-VEGF monotherapy in PCV

Small dome-shaped pigment epithelium detachment in polypoidal choroidal vasculopathy: an under-recognized sign of polypoidal lesions on optical coherence tomography?

To evaluate the diagnostic accuracy of spectral-domain optical coherence tomography (SD-OCT) and swept-source optical coherence tomographic angiography (SS-OCTA) to identify polypoidal lesions in serous or serosanguinous maculopathy. A retrospective review of patients presenting pigment epithelial detachments (PEDs) with the diagnosis of polypoidal choroidal vasculopathy (PCV), neovascular age-related macular degeneration (nAMD), and central serous chorioretinopathy (CSC), all of which underwent SD-OCT, SS-OCTA, and indocyanine green angiography (ICGA). Typical features of polypoidal lesions on SD-OCT included sharply peaked PED, notched PED, and hyperreflective ring underneath PED. SS-OCTA feature was vascularized PEDs on cross-sectional images corresponding to cluster-like structures on en face images. The parameters of PEDs were measured for analysis. Of 72 eyes, 30 had PCV, 22 had nAMD, and 20 had CSC. A total of 128 localized PEDs were detected on SD-OCT. Typical features on SD-OCT had a high specificity (94.0%) but a limited sensitivity (73.8%). SS-OCTA features provided a higher sensitivity (96.7%). PEDs of the polypoidal lesions unrecognized by SD-OCT were dome-shaped, with smaller ratio of height to base diameter and less area, and almost had heterogeneous internal reflectivity and a connected double-layer sign. Some lesions misidentified by SS-OCTA developed into ICGA-proven polypoidal lesions at follow-up visits. A small dome-shaped PED with heterogeneous internal reflectivity and a connected double-layer sign on SD-OCT may suggest a polypoidal lesion of PCV. SS-OCTA may be a helpful tool to investigate preclinical PCV and observe the formation of polypoidal lesions.

Polypoidal Choroidal Vasculopathy

A 76-year-old, hypertensive lady, presented with a three year history of gradual decrease in vision in her right eye. Examination revealed a large, bullous, serous pigment epithelial detachment (PED) of right fovea, a choroidal neovascular membrane, clusters of hard exudates, drusen and surrounding, multifocal, small PEDs. The left eye showed a series of small PEDs mostly on the inferior macula, pigmentary disturbance of the retinal pigment epithelium and scant hard exudates. A diagnosis of Polypoidal choroidal vasculopathy was made. We decided to treat her with intravitreal Bevacizumab injections in her right eye. At 18 months of follow up, her PEDs had resolved and visual acuity had improved from 6/60 OD to 6/36.&#x0D; Key Words: Polypoidal Choroidal Vasculopathy, Age Related Macular Degeneration, Pigment Epithelial Detachment, Choroidal Neovascular Membrane.