Investigation of precursor lesions of polypoidal choroidal vasculopathy using contralateral eye findings

Kang, Se Woong; Lee, Hoyoung; Bae, Ki Hwan; Shin, Joo Young; Kim, Sang Jin; Kim, Jong Min

doi:10.1007/s00417-016-3452-5

Cited by 30 publications

(19 citation statements)

References 34 publications

(41 reference statements)

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“…Isolated or scattered yellow‐white deposits in pachychoroid spectrum eyes that corresponded to homogenous sub‐RPE precipitations (or deposits) or RPE elevations as seen by OCT were previously called dot‐like precipitates, drusenoid RPE changes or drusen‐like deposits . Spaide classified drusen in non‐exudative AMD as typical soft drusen, subretinal drusenoid deposits (reticular pseudodrusen) and a new form of drusen according to morphological characteristics on fundus photographs and OCT.…”

Section: Discussionmentioning

confidence: 99%

Choroidal morphology under pachydrusen

Baek

Lee

Chung

et al. 2018

Clinical Exper Ophthalmology

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Importance To reveal choroidal morphological profiles under pachydrusen. Background Drusen in pachychoroid disorders show certain differences from conventional drusen and are recently named as “pachydrusen.” This study analysed the specific choroidal morphology under pachydrusen. Design This study is a cross‐sectional case series. Participants Enrolled were 136 eyes with pachydrusen from 134 patients. Methods The presence of pachydrusen in fundus area covered by a 12 × 9 mm2 optical coherence tomography (OCT) image was accessed in eyes with pachychoroid‐related diseases or their fellow eyes using colour fundus photography and swept source OCT. Choroidal morphology under the pachydrusen was analysed using OCT B‐scans and en face images. Main Outcome Measures Choroidal thicknesses and topographical correlation between pachydrusen and pachyvessels. Results A total of 225 pachydrusen in 136 eyes were analysed. The mean number of pachydrusen was 1.65 ± 1.07 per eye. Most pachydrusen were located para‐ or perifoveally (37 subfoveal, 86 parafoveal and 102 perifoveal). The proportion of Haller's layer to total choroidal thickness was higher at the area of the pachydrusen compared to the subfovea (0.881 ± 0.081 vs 0.765 ± 0.111, P < 0.001). In multimodal image analysis, 90.1% of pachydrusen identified using fundus photography and OCT B‐scan were located at the area of a dilated Haller vessel (pachyvessel) seen on en face images. Conclusions and Relevance Choroidal morphology under the pachydrusen showed increased Haller's layer thickness with an attenuated choriocapillaris layer, which is the hallmark of pachychoroid definition. Topographically, their locations correlated with the underlying pachyvessel.

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Section: Discussionmentioning

confidence: 99%

Choroidal morphology under pachydrusen

Baek

Lee

Chung

et al. 2018

Clinical Exper Ophthalmology

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“…The correlation between nAMD and clinical characteristics of non-neovascular fellow eyes has been studied previously 18–20. Available studies indicate a correlation between the subtype of neovascularization, based on the anatomical classification, and phenotypic characteristics of the non-neovascular fellow eyes 18,19.…”

Section: Discussionmentioning

confidence: 99%

Neovascular age-related macular degeneration without drusen in the fellow eye: clinical spectrum and therapeutic outcome

Chung¹,

Dijk²,

Mohabati³

et al. 2016

OPTH

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PurposeTo investigate the clinical characteristics and therapeutic outcome of patients with neovascular age-related macular degeneration (nAMD) in 1 eye, without drusen in the fellow eye.Patients and methodsMedical records of 381 patients were analyzed to identify the cases. The main outcomes included Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) and change in central retinal thickness (CRT). These parameters were reviewed at baseline, first follow-up visit, and after 6, 12, and 24 months.ResultsOut of 381 patients, 29 cases (8%) were included (of whom 3 had polypoidal choroidal vasculopathy [PCV]) who were treated with anti-vascular endothelial growth factor (anti-VEGF) therapy which was supplemented by photodynamic therapy (PDT) in the PCV patients. Overall, no statistically significant change in mean BCVA was observed during follow-up. BCVA improved or remained stable (defined as a gain in BCVA, a stable BCVA, or a loss of <5 ETDRS letters) in 22 patients (76%), and 7 patients (23%) had lost ≥5 ETDRS letters at final follow-up. A gain of ≥15 ETDRS letters at final follow-up was seen in 5 patients (17%). Mean CRT had decreased significantly with 99 µm (P<0.001) at 24 months after the initial visit.ConclusionThere is a clinical spectrum of nAMD that is not associated with drusen in the fellow eye. Patients with nAMD without drusen in the fellow eye respond to anti-VEGF treatment and, in cases of PCV, to supplemental PDT. The pathophysiology of this spectrum of nAMD may be different from drusen-associated age-related macular degeneration.

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“…This is in accordance with what already is known, and it is an important difference compared to typical AMD. 8,29 In contrast, pachydrusen were observed in higher percentages of affected and fellow eyes. The histopathologic nature of pachydrusen remains unknown, but the accumulation of any material below the RPE poses a possibility of some degree of RPE dysfunction.…”

Section: Discussionmentioning

confidence: 95%

Polypoidal Choroidal Vasculopathy: Outer Retinal and Choroidal Changes and Neovascularization Development in the Fellow Eye

Baek

Cheung

Lee

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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Citation: Baek J, Ceung CMG, Jeon S, Lee JH, Lee WK. Polypoidal choroidal vasculopathy: outer retinal and choroidal changes and neovascularization development in the fellow eye. Invest Ophthalmol Vis Sci. 2019;60:590-598. https://doi.org/10.1167/ iovs.18-24244 PURPOSE. We investigated the outer retinal, RPE, and choroidal changes and the development of choroidal neovascularization (CNV) in fellow eyes of patients with unilateral polypoidal choroidal vasculopathy or aneurysmal type 1 neovascularization (PCV/AT1). METHODS.In this retrospective observational cohort study, 263 patients with unilateral PCV/ AT1 were enrolled. Fundus photography, enhanced depth imaging optical coherence tomography, and indocyanine green angiography at baseline and follow-up were analyzed. Incidence and risk factors for the development of CNV were analyzed. RESULTS.In fellow eyes of unilateral PCV/AT1 cases, RPE and outer retinal abnormalities were observed in 222 (84%) eyes, and dilated Haller vessels (pachyvessel) were identified in the corresponding abnormality area in 157 (71%) eyes. Follow-up data were available for 233 patients. During a 27.6-month mean follow-up period, 20/233 (9%) eyes had CNV (12 PCV/ AT1 and eight type 1 CNV). In 18 eyes (90%), CNV developed at the RPE or outer retinal abnormality areas accompanied by pachyvessel. A significantly higher risk for CNV was observed if RPE and outer retinal abnormalities were accompanied by pachyvessel (hazard ratio, 9.3; 95% confidence interval, 1.1-75.9, P ¼ 0.037).CONCLUSIONS. RPE and outer retinal abnormalities were common in fellow eyes of patients presenting with unilateral PCV/AT1. CNV developed in fellow eyes of 9% of patients, frequently in the areas with RPE and outer retinal abnormality accompanied by pachyvessel.

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Investigation of precursor lesions of polypoidal choroidal vasculopathy using contralateral eye findings

Cited by 30 publications

References 34 publications

Choroidal morphology under pachydrusen

Choroidal morphology under pachydrusen

Neovascular age-related macular degeneration without drusen in the fellow eye: clinical spectrum and therapeutic outcome

Polypoidal Choroidal Vasculopathy: Outer Retinal and Choroidal Changes and Neovascularization Development in the Fellow Eye

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