Quantitative analysis of choroidal vasculature in polypoidal choroidal vasculopathy using ultra-widefield indocyanine green angiography

Abstract

Polypoidal choroidal vasculopathy (PCV) is a common choroidal vascular disease particularly in Asians. However, the underlying pathogenesis of PCV is still yet to be fully elucidated, and the correlation between choroidal vasculature and treatment response of PCV are poorly understood. Accordingly, we sought to find clues to understand the pathogenesis and prognosis of PCV by quantitatively evaluating choroidal vasculature from the entire fundus using ultra-widefield (UWF) indocyanine green angiography (ICGA). In this study, 32 eyes from 29 patients with treatment naïve PCV and 30 eyes from 30 healthy control participants were enrolled. Choroidal vascular density (CVD) of PCV eyes was higher than normal eyes in majority regions including the periphery. CVD was positively correlated with choroidal thickness and choroidal hyperpermeability, supporting that the pathogenesis of PCV may include choroidal congestion and dilatation. Thicker choroid and higher CVD were also correlated with poor treatment response after anti-VEGF injections. The CVD, quantified from UWF ICGA can also be used as an effective image biomarker to predict the treatment response in PCV.

Structural and Vascular Changes of the Choroid in Polypoidal Choroidal Vasculopathy after Intravitreal Anti-VEGF Therapy

“…Previous studies have used traditional imaging methods, such as SD-OCT and ICGA, that revealed in eyes with thicker choroids and choroidal hyperpermeability a less favorable anatomical and functional response after anti-VEGF therapy [5, 27, 30-33]. This is the first study using EDI-OCT and OCTA to evaluate how the choroid and CC changes can influence the visual outcome after anti-VEGF injections.…”

“…Although the pathogenesis remains still unclear, pachychoroid may induce the development of branching vascu-lar network [4]. Several studies reported that choroidal vasculature engorgement represents the leading etiology of PCV, demonstrating the primary role of the choroid in the neovascular process of PCV [5][6][7][8][9][10][11]. Multiple serous and serous-hemorrhagic pigment epithelial detachments (PEDs) are the most common clinical presentation, appearing as orange red nodules at fundus examination, located most frequently in the peripapillary area [12].…”

The Morphological Characteristics of Choriocapillaris In the Fellow Eyes of Polypoidal Choroidal Vasculopathy.Co-authors

“…CVH was more commonly seen in the eyes with pachychoroid 42 , but it also occurred in the PCV and fellow eyes. [43][44][45][46][47][48] A previous study in monkeys and rabbits had proved that the dye of ICGA was exuded and the CVH was formed due to vascular endothelial damage, 49 suggested that CVH[+] exhibits vessel abnormalities at the innermost choroid. Based on the mechanism of OCTA, the blood ow signals came from the movement of red blood cells 6 , the decrease of the area without blood ow signals (FV) means that the area occupied by red blood cells increased, however, the red blood cells should not exist outside the vessels.…”

Intraoperative fluorescence with indocyanine green in congenital cardiac surgery: Potential applications of a novel technology

“…We used ICG/IOFA in 4 patients to assess the quality and patency of vascular anastomoses in 4 different clinical scenarios 1 : left subclavian–to–left common carotid artery as a part of complete repair of a vascular ring (right aortic arch with aberrant retroesophageal left subclavian artery and persistent Kommerell diverticulum), 2 repair of aortic coarctation, 3 repair of an interrupted aortic arch ( Figure 2 , C ), and 4 reconstructed pulmonary arterial branches in a 10-month-old girl with congenital pulmonary valve and bilateral branch pulmonary artery stenoses ( Figure E1 , A and B ).…”

“…When ICG is exposed to near-infrared rays, it generates fluorescence. 2 IOFA has been widely used in other specialties, including ophthalmology, 3 gastrointestinal surgery, 4 and sentinel node mapping in breast cancer 5 ; however, application of this technology has been quite limited in cardiac surgery in general and in congenital cardiac surgery in particular. Here we present our experience using this technology.…”