The Noninvasive Retro-Mode Imaging Modality of Confocal Scanning Laser Ophthalmoscopy in Polypoidal Choroidal Vasculopathy: A Preliminary Application

Abstract

PurposeTo evaluate the validity of the novel and noninvasive retro-mode imaging modality of confocal scanning laser ophthalmoscopy (cSLO) for detecting the morphological features of polypoidal choroidal vasculopathy (PCV).DesignProspective, observational, consecutive case series.MethodsTwenty-six patients (29 eyes) with PCV were enrolled in this study. All patients underwent comprehensive ophthalmologic examinations and imaging studies, including retro-mode imaging, fundus autofluorescence (FAF), fundus photography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and spectral-domain optical coherence tomography (SD-OCT). We investigated the retro-mode images and compared the results with those of SD-OCT, FFA and ICGA.ResultsIn the 29 PCV eyes, the retro-mode images clearly revealed polypoidal lesions in 27 (93.1%) eyes as well as branching vascular networks in 16 (55.2%) eyes. Others findings, including pigment epithelial detachment (PED) in 20 (69.0%) eyes, neuroretinal detachment (NRD) in 3 (10.3%) eyes, cystoid macular edema (CME) in 3 (10.3%) eyes, drusen in 4 (13.8%) eyes and minute granular changes of the retinal pigment epithelium (RPE) in 12 (41.3%) eyes, were also clearly visualized. When we compared the results with those of SD-OCT, FFA and ICGA, there was no significant difference between ICGA and retro-mode imaging for finding polypoidal lesions and (or) branching choroidal vascular networks (P>0.05). However, the rate of PED detection was significantly better with retro-mode imaging than with the ICGA (P<0.05). The differences were not statistically significant between SD-OCT and retro-mode imaging for detecting PED, NRD, CME, drusen and minute granular RPE changes (P>0.05). The differences were not statistically significant between FFA and retro-mode imaging for detecting PED, NRD, CME (P>0.05).ConclusionsThe novel and noninvasive retro-mode imaging by cSLO is able to clearly visualize the morphological features of PCV.

Polypoidal Choroidal Vasculopathy in Asians

“…Retro-mode imaging with the confocal scanning laser ophthalmoloscope (cSLO) has recently been investigated as a potential non-invasive test for PCV diagnosis [ 137 , 138 ]. The cSLO normally collects directly backscattered light from the confocal plane through a confocal aperture.…”

“…evaluated this imaging modality in 29 eyes with PCV and found that 93.1% of eyes with polyps were clearly imaged, and detected BVN in 55.2%. They found no difference between retro-mode imaging and ICGA for finding polyps and/or BVN [ 137 ]. However, retro-mode imaging is unable to detect disease activity and is not able to localize the depth of the lesion, thereby limiting it to a complementary role.…”

The noninvasive retro-mode imaging of confocal scanning laser ophthalmoscopy in myopic maculopathy: a prospective observational study

“…5 Recently, retro-mode imaging (RMI) with infrared lasers (Nidek F-10, Gamagori, Japan) and a confocal scanning laser ophthalmoscope (cSLO) (based on the principles of retro-illumination) were used to investigate several fundus pathologies. 6 Cystoid macular edema, 7 polypoidal choroidal vasculopathy, 8,9 subthreshold laser scars, 10 drusen, 11 retinal atrophy, 12 macular dystrophies, 13 idiopathic macular holes 14 and RPE alterations in the central serous chorioretinopathy, 6,15 and age-related macular degeneration 16 were observed using this technique; the results implied that RMI could be useful in the study of deep retinal pathologies, RPE changes, and even choroidal lesions. In contrast with biomicroscopic examination, RMI enables the observation of the cystoid spaces and retinal microfolds underlying the epiretinal membrane from a threedimensional perspective.…”

Retromode Scanning Laser Ophthalmoscopy for Choroidal Nevi: A Preliminary Study

“…In previous research, RM imaging has been used to evaluate pathologic changes in several retinal and choroidal diseases, including RPE alterations in central serous chorioretinopathy, macular retinoschisis in myopic maculopathy, diabetic macular edema, abnormalities in polypoidal choroidal vasculopathy, hydroxychloroquine retinopathy, age-related macular degeneration and drusen, sites of subthreshold laser scars and abnormalities in a variety of chorioretinal dystrophies [ 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. These prior studies indicated that RM imaging could be useful in studying deep retinal pathologies, RPE and choroid changes due to the use of infrared light, which allows for deeper penetration than shorter wavelengths [ 7 , 8 , 10 ].…”