Clinical features and prognosis of polypoidal choroidal vasculopathy with different morphologies of branching vascular network on optical coherence tomography angiography

Abstract

This study highlights the clinical features and treatment response of polypoidal choroidal vasculopathy (PCV) among three different branching vascular network (BVN) morphologies in optical coherence tomography angiography (OCTA), and further correlates the BVN features with those under fluorescent angiography (FA) and indocyanine green angiography (ICGA). In total, we reviewed 70 eyes with PCV followed up for > 12 months. OCTA, ICGA and FA images were obtained at baseline and post-treatments. BVN was assessed using OCTA and divided into three types by a previously described BVN classification: type 1 (trunk), type 2 (glomeruli), and type 3 (stick). At baseline, type 1 BVN had the poorest vision and thinnest subfoveal choroidal thickness (SFCT), whereas type 3 had the best vision and thickest SFCT. The aforementioned trend sustained after treatments. Each BVN morphology in OCTA showed typical features in FA + ICGA and encompassed significant correlation (p = 0.004). In conclusion, OCTA is an innovative imaging tool for the detection and classification of BVN in PCV. Furthermore, OCTA has advantages of being noninvasive and free of systemic toxicities. The BVN can be divided into three types based on morphological characteristics in OCTA, which play crucial roles in clinical presentations and treatment outcomes.

Polypoidal Choroidal Vasculopathy: An Update on Diagnosis and Treatment

“…Type 2 and 3 were associated with thicker choroids and increased recurrences, while type 1 was associated with the thin choroid, drusen, and AMD-like features. Ma et al 60 found that, for most patients, type 1, 2, and 3 BNN corresponded to Type C, B, and A BNN, respectively, as described by Tan et al based on FFA and ICGA. IRC was most seen with type 1, which also had the worse BCVA both at baseline and after treatment.…”

“…Huang et at 59 described three different BNN on OCTA: Type 1(trunk form, larger), type 2 (glomeruli form), and type 3 (stick form, smallest). Ma et al 60 described the effect of these patterns of BNN as seen on OCTA on treatment response and outcome in PCV. Type 2 and 3 were associated with thicker choroids and increased recurrences, while type 1 was associated with the thin choroid, drusen, and AMD-like features.…”

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

“…Allowing some PLs to be recognized as tangled vascular structures associated with BVNs, might also help understand the role of neovascularization in the etiology of PCV and possible implications in treatment. In addition, investigators previously used SD-OCTA to classify BVNs into different subtypes based on their morphological features, where these classification systems showed some consistency with those based on ICGA and fundus fluorescence angiography (FFA) in predicting visual prognosis [45,46]. Using SS-OCTA, BVNs can be described with more morphological patterns, such as dense, very dense (bush-shaped), loose (dead-tree-shaped), pseudopod-like, and anastomosing forms.…”

Advances in multi-modal non-invasive imaging techniques in the diagnosis and treatment of polypoidal choroidal vasculopathy

“…Bo et al (42) defined exudative recurrence as the reappearance of IRF, SRF, or serous PED OCT, or the appearance of new subretinal or RPE hemorrhage on fundus photography. Ma et al (43) described the impact of different BNN patterns observed on OCTA on the treatment response and outcomes of PCV and found that type 2 ("Glomeruli" pattern) and type 3 ("Stick" pattern) were associated with thicker choroid and increased recurrence of PCV, while type 1 ("Trunk" pattern) was associated with thin choroid, vitelliform lesions, and AMD-like features. However, because OCTA cannot display vascular leakage, it is currently primarily used in combination with structural OCT for treatment monitoring and as a reference for recurrence treatment decisions.…”