Choroidal Structural Changes Correlate With Neovascular Activity in Neovascular Age Related Macular Degeneration

Invernizzi, Alessandro; Benatti, Eleonora; Cozzi, Mariano; Erba, Stefano; Vaishnavi, Shiva; Vupparaboina, Kiran Kumar; Staurenghi, Giovanni; Chhablani, Jay; Gillies, Mark C; Viola, Francesco

doi:10.1167/iovs.18-23960

Cited by 43 publications

(25 citation statements)

References 24 publications

(35 reference statements)

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“…This result was interpreted as a sign of subclinical choroidal ischemia, which may precede the typical manifestations of AMD such as CNV. Another recent study described an increase of choroidal vascularity in eyes with AMD before development or reactivation of CNV [26]. Therefore, serial CVI measurement might be a useful tool to predict the development or reactivation of CNV in patients with AMD.…”

Section: Discussionmentioning

confidence: 97%

Short-term choroidal vascular changes after aflibercept therapy for neovascular age-related macular degeneration

Pellegrini

Bernabei

Mercanti

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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Introduction The purpose of this study was to evaluate choroidal vascular changes in patients with neovascular age-related macular degeneration (nAMD) treated with aflibercept injection over a 3-month period. Methods Enhanced depth imaging optical coherence tomography scans of 60 eyes with treatment-naïve nAMD and 60 unaffected fellow eyes were retrospectively analyzed. Data was collected at baseline and after 3 monthly intravitreal injections of aflibercept. The ImageJ software was used to binarize OCT scans and measure total choroid area (TCA), luminal area (LA), and stromal area (SA). Choroidal vascularity index (CVI) was defined as the ratio of LA to TCA. Results After treatment, subfoveal choroidal thickness (CT) in nAMD eyes significantly decreased from 210. 6 ± 61.6 to 194.6 ± 58.7 μm (P < 0.001), TCA from 1.620 ± 0.502 to 1.500 ± 0.451 mm2 (P < 0.001), LA from 1.075 ± 0.335 to 0.985 ± 0.307 mm2 (P < 0.001), SA from 0.545 ± 0.176 to 0.516 ± 0.153 mm2 (P = 0.005), and CVI from 66.36 ± 2.89 to 65.46 ± 2.87% (P = 0.009). The decrease of CVI after treatment was significantly correlated with baseline CVI (Rs = 0.466, P < 0.001), but not with the change in BCVA and presence of dry macula after treatment (always P > 0.05). Conclusion Choroidal thickness and vascularity significantly decreased after treatment with aflibercept in nAMD eyes. Besides the pharmacologic effect on the neovascular lesion, aflibercept may induce vascular changes also on the underlying choroid.

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Section: Discussionmentioning

confidence: 97%

Short-term choroidal vascular changes after aflibercept therapy for neovascular age-related macular degeneration

Pellegrini

Bernabei

Mercanti

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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“…These results may suggest a stromal replacement of the choroidal vessels occurring in the setting of GA [59]. Invernizzi and colleagues performed a longitudinal analysis to correlate changes in CT and CVI with disease activity in eyes with neovascular AMD [60].…”

Section: In Age-related Macular Degenerationmentioning

confidence: 99%

“…Of note, only type 1 lesions demonstrated statistically significant modifications in CVI from the inactive to the active form of the disease. The authors argued that these results may be secondary to the fact that type 1 CNV is located beneath the RPE, which may increase the diffusion of inflammatory mediators within the choroid [60].…”

Section: In Age-related Macular Degenerationmentioning

confidence: 99%

Choroidal Vascularity Index: An In-Depth Analysis of This Novel Optical Coherence Tomography Parameter

Iovino

Pellegrini

Bernabei

et al. 2020

JCM

157

128

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Remarkable improvements in optical coherence tomography (OCT) technology have resulted in highly sophisticated, noninvasive machines allowing detailed and advanced morphological evaluation of all retinal and choroidal layers. Postproduction semiautomated imaging analysis with dedicated public-domain software allows precise quantitative analysis of binarized OCT images. In this regard, the choroidal vascularity index (CVI) is emerging as a new imaging tool for the measurement and analysis of the choroidal vascular system by quantifying both luminal and stromal choroidal components. Numerous reports have been published so far regarding CVI and its potential applications in healthy eyes as well as in the evaluation and management of several chorioretinal diseases. Current literature suggests that CVI has a lesser variability and is influenced by fewer physiologic factors as compared to choroidal thickness. It can be considered a relatively stable parameter for evaluating the changes in the choroidal vasculature. In this review, the principles and the applications of this advanced imaging modality for studying and understanding the contributing role of choroid in retinal and optic nerve diseases are discussed. Potential advances that may allow the widespread adoption of this tool in the routine clinical practice are also presented.

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“…One hypothesis is that ischemia in areas of choriocapillary flow reductions/flow voids dictates the location in which neovascular lesions develop. Choroidal thickness measurements in neovascular AMD have been inconsistent; some groups report eyes with choroidal neovascularization have thinner choroids than age-matched healthy controls (Chung et al 2011), while the development of active or recurrent exudative neovascular AMD has also been associated with increased subfoveal choroidal thickness (Bouteleux et al 2019;Invernizzi et al 2018). This increased choroidal thickness has been shown to be accompanied by an increase in the choroidal vascularity index (Invernizzi et al 2018), suggesting the change may be due to neovascularization within the choroid rather than edematous thickening.…”

Section: Changes In the Choroid In Late Amdmentioning

confidence: 99%

“…Choroidal thickness measurements in neovascular AMD have been inconsistent; some groups report eyes with choroidal neovascularization have thinner choroids than age-matched healthy controls (Chung et al 2011), while the development of active or recurrent exudative neovascular AMD has also been associated with increased subfoveal choroidal thickness (Bouteleux et al 2019;Invernizzi et al 2018). This increased choroidal thickness has been shown to be accompanied by an increase in the choroidal vascularity index (Invernizzi et al 2018), suggesting the change may be due to neovascularization within the choroid rather than edematous thickening. Several studies have demonstrated that OCTA can accurately identify choroidal neovascularization (de Carlo et al 2015;Jia et al 2014Jia et al , 2015, offering a clear depiction of the CNV net (Fig.…”

Section: Changes In the Choroid In Late Amdmentioning

confidence: 99%

Microvascular contributions to age-related macular degeneration (AMD): from mechanisms of choriocapillaris aging to novel interventions

et al. 2019

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Aging of the microcirculatory network plays a central role in the pathogenesis of a wide range of agerelated diseases, from heart failure to Alzheimer's disease. In the eye, changes in the choroid and choroidal microcirculation (choriocapillaris) also occur with age, and these changes can play a critical role in the pathogenesis of age-related macular degeneration (AMD). In order to develop novel treatments for amelioration of choriocapillaris aging and prevention of AMD, it is essential to understand the cellular and functional changes that occur in the choroid and choriocapillaris during aging. In this review, recent advances in in vivo analysis of choroidal structure and function in AMD patients and patients at risk for AMD are discussed. The pathophysiological roles of fundamental cellular and molecular mechanisms of aging including oxidative GeroScience

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Choroidal Structural Changes Correlate With Neovascular Activity in Neovascular Age Related Macular Degeneration

Abstract: Choroidal thickness and CVI significantly increased with active disease in nAMD eyes. Changes in choroidal thickness may predict CNV development or recurrence before they are otherwise evident clinically.

Cited by 43 publications

References 24 publications

Short-term choroidal vascular changes after aflibercept therapy for neovascular age-related macular degeneration

Short-term choroidal vascular changes after aflibercept therapy for neovascular age-related macular degeneration

Choroidal Vascularity Index: An In-Depth Analysis of This Novel Optical Coherence Tomography Parameter

Microvascular contributions to age-related macular degeneration (AMD): from mechanisms of choriocapillaris aging to novel interventions

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