Changes of choroidal structure after intravitreal aflibercept therapy for polypoidal choroidal vasculopathy

Daizumoto, Erina; Mitamura, Yoshinori; Sano, Hiroki; Akaiwa, Kei; Niki, Masanori; Yamanaka, Chihiro; Kinoshita, Takamasa; Egawa, Mariko; Sonoda, Shozo; Sakamoto, Taiji

doi:10.1136/bjophthalmol-2016-309694

Cited by 19 publications

(22 citation statements)

References 22 publications

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“…14 In addition, the choroidal vascular area (luminal area) was positively correlated with the total choroidal thickness, consistent with our findings. These authors showed that there was no difference in choroidal vasculature or choroidal thickness between active and resolved eyes with CSC, which is also consistent with our results; however, some other authors have reported that the outer choroidal vascular dilatation was reduced after anti-VEGF therapy 29 or PDT. 15 Our results showed that both choroidal vasculature and stromal components remained unchanged in patients with CSC or PNV after anti-VEGF treatment during a relatively short-term follow-up period (Fig.…”

Section: Discussionsupporting

confidence: 93%

Changes in Stromal and Luminal Areas of the Choroid in Pachychoroid Diseases: Insights Into the Pathophysiology of Pachychoroid Diseases

Lee

Kim

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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Citation: Lee M, Lee H, Kim HC, Chung H. Changes in stromal and luminal areas of the choroid in pachychoroid diseases: insights into the pathophysiology of pachychoroid diseases. Invest Ophthalmol Vis Sci. 2018;59:4896-4908. https://doi.org/ 10.1167/iovs.18-25018 PURPOSE.To evaluate and compare changes in choroidal vascular and stromal areas in patients with three major pachychoroid diseases for better insight into the pathophysiology of these diseases.METHODS. Eighty-six eyes of 86 patients (50 men and 36 women; mean age, 49.1 years) were evaluated, including 21 patients with chronic central serous chorioretinopathy (CSC), 14 with pachychoroid pigment epitheliopathy (PPE), 19 with pachychoroid neovasculopathy (PNV), 14 with myopic choroidal neovascularization (mCNV), and 18 controls. Multimodal retinal imaging, including enhanced-depth imaging optical coherence tomography (EDI-OCT), was performed. Each EDI-OCT image was binarized with ImageJ software, and luminal (dark pixels) and stromal (light pixels) areas were calculated (3000 lm wide in the subfoveal choroid centered on the fovea). RESULTS.The subfoveal choroidal thickness (SFCT) was greater in the three pachychoroid groups than in the control group (430.01 vs. 282.61 lm, P < 0.001). There was no significant difference in SFCT among the three pachychoroid groups. The luminal-to-total choroidal ratio (L/C) was highest (ANOVA, P ¼ 0.001) and the stromal-to-total choroidal ratio (S/C) lowest in the CSC group (ANOVA, P ¼ 0.001). Interestingly, stromal area changes were not correlated with SFCT in the CSC and PNV groups, in contrast to the good correlation between luminal area changes and SFCT in these groups.CONCLUSIONS. The eyes of CSC patients had significantly smaller choroidal stromal areas than those of controls or of PPE, PNV, or mCNV patients. The differences in choroidal stromal area, L/C, and S/C in different pachychoroid diseases may reflect different predominant pathogenic processes.

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Section: Discussionsupporting

confidence: 93%

Changes in Stromal and Luminal Areas of the Choroid in Pachychoroid Diseases: Insights Into the Pathophysiology of Pachychoroid Diseases

Lee

Kim

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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“…There have been few studies to-date to examine the longitudinal changes in the detailed sub-components of the choroid. In a recent study by Daizumoto and coauthors 23 , they subdivided the choroidal layers into inner and outer layers at the subfoveal 1500 µm region. In 40 treatment-naïve PCV patients, they found that the inner choroid SA and outer choroid LA decreased significantly at month 3 and month 12 after intravitreal aflibercept.…”

Section: Discussionmentioning

confidence: 99%

Choroidal Remodeling in Age-related Macular Degeneration and Polypoidal Choroidal Vasculopathy: A 12-month Prospective Study

Ting

Yanagi

Agrawal

et al. 2017

Sci Rep

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Choroid thinning occurs in age-related macular degeneration (AMD). However, it remains unclear whether the reduction is due to reduction in choroidal vessels or shrinkage of choroidal stroma, or both. The purpose of this study was to evaluate the changes of the choroidal vascular and stromal area in 118 patients with typical AMD (t-AMD) and polypoidal choroidal vasculopathy (PCV) over a 12-month period. We used spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging (EDI) mode to measure the subfoveal choroidal thickness (CT), central retinal thickness (CRT) and choroidal vascularity index (CVI - ratio of luminal area to total choroidal area). At baseline, PCV eyes had higher CRT (471.6 µm vs 439.1 µm, p = 0.02), but comparable subfoveal CT and CVI, compared to t-AMD. Eyes with high CVI at baseline showed marked reduction in stromal area compared with eyes with average or low CVI. Over 12 months, CRT and subfoveal CT significantly decreased (p < 0.001) in both subtypes. Eyes with high baseline CVI showed significant CVI reduction from baseline to month 12 (p < 0.001), whereas eyes with average to low baseline CVI showed increase in CVI. These differences in choroidal vascularity may reflect different predominant pathogenic processes and remodeling in AMD eyes with varying spectrum.

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“…20 In eyes from diabetic patients and eyes with exudative AMD, there were decreased CVI with no significant change in CT. 26,28,29 CVI was also shown to provide additional information to CT in terms of longitudinal choroidal structural changes in diseases such as panuveitis 20 ; Vogt-Koyanagi-Harada (VKH) disease 25 ; central serous chorioretinopathy (CSCR) 24 ; and myopic choroidal neovascularization. 27 Changes in L/C ratio or a similar index called L/S ratio (ratio of choroidal luminal area to stromal area) were investigated and found to yield valuable information in normal physiologic conditions including diurnal variation 22 and dynamic exercise 23 as well as in a number of ocular diseases including exudative AMD 21 ; polypoidal choroidal vasculopathy (PCV) 34 ; CSCR 32,33 ; VKH disease 30,31 ; and retinitis pigmentosa. 36 In this study, we compared the agreement between markers of choroidal vascularity (CVI and L/C ratio) measured by twoimage binarization techniques and significant differences were found between the two measurements.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Choroidal Vascularity Markers on Optical Coherence Tomography Using Two-Image Binarization Techniques

Wei

Sonoda

Mishra

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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METHODS. Spectral-domain OCT using enhanced-depth imaging was performed in 100 eyes from 52 normal subjects. Choroidal images were binarized to luminal area and stromal area using two different algorithms. Choroidal vascularity marker was defined as the ratio of luminal area to total choroidal area and they were termed ''luminal/choroidal area ratio (L/C ratio)'' and ''choroidal vascularity index (CVI)'' per the algorithm. The agreement between choroidal vascularity markers measured by the two techniques was compared using intraclass correlation coefficient (ICC) and Bland-Altman analysis. RESULTS.The mean values of choroidal vascularity markers were 70.12% (range, 56.76%-78.55%) for CVI and 67.44% (range, 51.09%-81.31%) for L/C ratio. Low level of absolute agreement between the two binarization techniques was reflected by an adjusted ICC of 0.353 using linear mixed model with age, sex, and spherical equivalent as covariates.CONCLUSIONS. There was discrepancy between measurements of choroidal vascularity using two commonly adopted image binarization techniques. It remained unclear what was the true choroidal vascularity and which binarization algorithm was more accurate. Future studies with enhanced image quality and improved image analysis algorithm are required to decipher the ground truth for choroidal vascularity.

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Changes of choroidal structure after intravitreal aflibercept therapy for polypoidal choroidal vasculopathy

Abstract: The binarisation of the EDI-OCT images can be used to quantify the activity of PCV and to predict the prognosis after IVA.

Cited by 19 publications

References 22 publications

Changes in Stromal and Luminal Areas of the Choroid in Pachychoroid Diseases: Insights Into the Pathophysiology of Pachychoroid Diseases

Changes in Stromal and Luminal Areas of the Choroid in Pachychoroid Diseases: Insights Into the Pathophysiology of Pachychoroid Diseases

Choroidal Remodeling in Age-related Macular Degeneration and Polypoidal Choroidal Vasculopathy: A 12-month Prospective Study

Comparison of Choroidal Vascularity Markers on Optical Coherence Tomography Using Two-Image Binarization Techniques

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