Indocyanine Green Angiography of Pachychoroid Pigment Epitheliopathy

Abstract

Pachychoroid pigment epitheliopathy is forme fruste of CSC. There is no difference between complicated and UCP regarding subfoveal choroidal thickness and choroidal vessel density. The main difference between these groups is choroidal hyperpermeability.

Pachychoroid disease

“…Choroidal hyperpermeability is believed to result from increased extravasation of fluid and lipoprotein-bound ICGA from the choriocapillaris or the larger choroidal vessels into the surrounding choroidal stroma. Previous studies have reported choroidal hyperpermeability to be present in >90% of eyes with PPE and CSC [27], and in 10-50% of eyes with PCV [2,18]. Punctate hyperfluorescence spots have also been observed in the mid to late phase of ICGA in eyes with CSC and PCV [18,31].…”

“…Punctate hyperfluorescence spots have also been observed in the mid to late phase of ICGA in eyes with CSC and PCV [18,31]. Both diffuse and punctate hyperfluorescent spots have been frequently observed in contralateral eyes of patients with CSC and PCV without overt pathology [27,30]. These ICGA findings characteristically persist in eyes with CSC even after resolution of SRF [30].…”

“…Eyes with choroidal hyperpermeability usually have increased choroidal thickness, but not all eyes with thick choroids exhibit choroidal hyperpermeability [32]. Interestingly, choroidal hyperpermeability was reported to be more common in eyes with CSC and PPE than in eyes with uncomplicated pachychoroid [27]. As choroidal hyperpermeability may indicate structural choriocapillaris damage producing relative ischemia, this finding suggests functional implications of the pachychoroid phenotype beyond increased choroidal thickness.…”

“…In addition to choroidal venous dilatation, choroidal filling defects, delayed arterial filling in the early phase, and focal or punctate hyperfluorescence have been observed in eyes with CSC, PCV, and FCE, suggestive of possible choroidal ischemia [27][28][29][30]. In the mid to late phase, patchy areas of ICGA hyperfluorescence can be seen corresponding to the leakage and staining sites observed on fluorescein angiography (FA) [27][28][29][30]. Choroidal hyperpermeability is believed to result from increased extravasation of fluid and lipoprotein-bound ICGA from the choriocapillaris or the larger choroidal vessels into the surrounding choroidal stroma.…”

Peripapillary Pachychoroid Syndrome

“…In addition, pigmentary changes in a leopard-spot pattern characteristic of UES were not identified in our patients; 2) ICGA in our patients was very characteristic for PDS and included typical findings such as dilated large choroidal veins (pachyvessels) and choroidal hyperpermeability. 1,4,12,13 The pachyvessels were identified during dye transit and washed out in the late phase of the study. These pachyvessels corresponded to dilated Haller layer vessels visible on structural EDI-OCT and typically illustrated attenuation of the overlying Sattler layer and choriocapillaris.…”