Venous overload choroidopathy: A hypothetical framework for central serous chorioretinopathy and allied disorders

Spaide, Richard F.; Cheung, Chui Ming Gemmy; Matsumoto, Hidetaka; Kishi, Shoji; Boon, Camiel J F; Dijk, Elon H. C. van; Mauget‐Faÿsse, Martine; Béhar-Cohen, Francine; Hartnett, M. Elizabeth; Sivaprasad, Sobha; Iida, Tomohiro; Brown, David M.; Chhablani, Jay; Maloca, Peter

doi:10.1016/j.preteyeres.2021.100973

Cited by 145 publications

(174 citation statements)

References 200 publications

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“…Vortex vein ampullas and the intrascleral portion of vortex veins have been proposed as sites of choroidal outflow regulation through flow resistance modulation and implicated in mechanisms producing choroidal venous congestion in pachychoroid disease entities. 33 , 47 Supporting this hypothesis is the finding of increased scleral thickness in CSC eyes compared to normal eyes that could limit both choroidal venous outflow and transscleral fluid resorption. 48 , 49 …”

Section: Discussionmentioning

confidence: 99%

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Ultra-Widefield Indocyanine Green Angiography Reveals Patterns of Choroidal Venous Insufficiency Influencing Pachychoroid Disease

Bacci

Singer

et al. 2022

Invest. Ophthalmol. Vis. Sci.

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Purpose To compare patterns of choroidal venous drainage in eyes with pachychoroid disease to those of healthy subjects using ultra-widefield indocyanine green angiography (UWF ICGA). Methods Patients with pachychoroid disease and healthy controls were recruited at two referral centers. UWF ICGA images were used to evaluate the proportion of the postequatorial fundus drained by major vortex vein systems in each quadrant and to study the incidence and topography of choroidal vascular hyperpermeability (CVH) and intervortex venous anastomoses. Widefield swept-source optical coherence tomography (SS-OCT) was used to evaluate choroidal thickness at the posterior pole in eyes with pachychoroid disease. Results Fifty-two pachychoroid eyes and 26 healthy eyes were evaluated. Eyes with pachychoroid disease showed a significant within-subject variance in the proportion of the postequatorial fundus drained by each vortex vein system (range, 4.1%–48.1%; P < 0.0001) that was not seen in controls (range, 17.3%–31.7%; P = 0.11). CVH was present in all pachychoroid disease eyes and three of 26 controls. Intervortex venous anastomoses were present in 46 of 52 pachychoroid disease eyes and nine of 26 control eyes. Vortex vein systems with large drainage areas showed greater density of CVH spots. SS-OCT demonstrated asymmetric choroidal drainage in the macula of 59% of pachychoroid eyes. CVH and intervortex venous anastomoses were more prominent in areas showing maximal choroidal thickness. Conclusions In eyes with pachychoroid disease, imbalanced choroidal venous drainage with congestion of specific vortex vein systems may contribute to a state of choroidal venous insufficiency characterized by regional choroidal thickening, CVH and remodeling of venous drainage routes.

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Section: Discussionmentioning

confidence: 99%

“…The idea that pachychoroid disease is related to alteration of the choroidal venous homeostasis has gained consensus in the scientific community. 33 Nevertheless, the mechanisms by which venous congestion is produced in the choroid of eyes with pachychoroid disease remain poorly understood.…”

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confidence: 99%

Ultra-Widefield Indocyanine Green Angiography Reveals Patterns of Choroidal Venous Insufficiency Influencing Pachychoroid Disease

Bacci

Singer

et al. 2022

Invest. Ophthalmol. Vis. Sci.

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“…The significant correlation between CNV lesions and complex CSCR is likely to depend on the associated epitheliopathy, as suggested by numerous reports identifying epitheliopathy and long-lasting SRF as important predisposing factors for CNV development [ 2 , 7 , 26 ]. Epitheliopathy, underlying choroidal abnormalities, and choroidal blood flow deregulation seem to play critical roles [ 25 , 27 , 28 ]. Vascular remodeling in the context of venous overload may also predispose to CNV occurrence [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

OCT Angiography Fractal Analysis of Choroidal Neovessels Secondary to Central Serous Chorioretinopathy, in a Caucasian Cohort

Serra

Pinna

Béhar-Cohen

et al. 2022

JCM

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Central serous chorioretinopathy (CSCR) can be complicated by different types of choroidal neovascularization (CNV). The purpose of this study was to investigate the incidence and quantitative optical coherence tomography angiography (OCT-A) features of CSCR-related CNVs. Methods: This was a retrospective multicenter study including 102 eyes of 102 Caucasian patients with acute or complex CSCR. All patients underwent a comprehensive ophthalmological examination. Quantitative OCT-A parameters, including vascular perfusion density (VPD), fractal dimension (FD), and lacunarity (LAC), were measured in CNV eyes. Results: Forty eyes (39.2%) had acute CSCR, whereas the remaining sixty-two (60.8%) had complex CSCR. CNV was observed in 37 (36.27%) eyes, all of which had the complex form. CNVs were classified as type 1 CNV in 11/37 (29.73%) cases and as polypoidal choroidal vasculopathy (PCV) in the remaining 26/37 (70.27%). Overall, the mean VPD, FD, and LAC of CSCR-related CNVs were 0.52 ± 0.20%, 1.44 ± 0.12, and 2.40 ± 1.1, respectively. No significant difference between type 1 CNV and PCV was found. Conclusion: Complex CSCR is often complicated by type 1 CNV and PCV with similar neovascular architecture and branching complexity, a finding supporting the idea that they might be different stages of the same neovascular process. Future OCT-A fractal analysis-based studies that also include other relevant parameters, such as demographics, presentation, morphology on multimodal imaging, and response to treatment, are necessary before drawing any definitive conclusions.

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“…In particular, Matsumoto and colleagues 26 demonstrated the remodeling of choroidal drainage routes by the development of anastomotic connections between superotemporal and inferotemporal vortex vein systems at the posterior pole in eyes with PNV. Spaide et al 27 introduced the concept of venous overload choroidopathy to explain the vascular abnormalities shared by all the pachychoroid disorders. We found that both the presence of early ICGA pachyvessels crossing over the macula and SFCT > 300 μm and were predictors of pMNV.…”

Section: Discussionmentioning

confidence: 99%

InCASEOf scoring system for distinction between pachychoroid-associated macular neovascularization and neovascular age-related macular degeneration in patients older than 50 years

Cozzupoli

Borrelli

Capuano

et al. 2022

Sci Rep

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To develop a novel scoring system aiming at guiding the differential diagnosis between macular neovascularization secondary to pachychoroid disease (pMNV) and neovascular age-related macular degeneration (AMD) in patients aged 50 years and older. In this retrospective study performed at University Vita-Salute San Raffaele (Milan, Italy) and Créteil University Eye Clinic (Créteil, France), we enrolled patients 50 years of age and older, visited between January 2017 and January 2019, who were diagnosed with either treatment-naïve pMNV or neovascular AMD. At the time of diagnosis, all patients underwent a comprehensive ophthalmologic evaluation, spectral-domain optical coherence tomography, fluorescein angiography, indocyanine green angiography, and optical coherence tomography angiography. Univariate comparison between pMNV and neovascular AMD groups was performed to identify the main clinical predictors for pMNV. The selected predictors were taken into a binomial logistic regression and eventually served as the basis for the development of InCASEOf scoring system. Receiver operating characteristic (ROC) curves were used to study the model performance. Forty-eight right eyes from 48 patients with pMNV and 39 right eyes from 39 patients with neovascular AMD were considered in this study. Age (+ 2 points), sex (+ 2 points), choroidal thickness (+ 2 points), early pachyvessels (+ 2 points), and evidence of MNV at OCTA (+ 3 points) turned out to be predictors for pMNV. Four additional factors significant at univariate analysis were considered: type 2 and type 3 MNVs and presence of intraretinal fluid (− 0.5 points each), and presence of subretinal fluid (+ 0.5 points). InCASEOf scoring system was built with a high score of 11.5 points. The cutoff value of 6.5 showed good accuracy in separating pMNVs from neovascular AMDs. InCASEOf is a straightforward clinical scoring system, accessible to comprehensive ophthalmologists, with the purpose of enabling easy distinction and expert-like diagnosis of pMNV and neovascular AMD in patients aged 50 years or older.

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Venous overload choroidopathy: A hypothetical framework for central serous chorioretinopathy and allied disorders

Cited by 145 publications

References 200 publications

Ultra-Widefield Indocyanine Green Angiography Reveals Patterns of Choroidal Venous Insufficiency Influencing Pachychoroid Disease

Ultra-Widefield Indocyanine Green Angiography Reveals Patterns of Choroidal Venous Insufficiency Influencing Pachychoroid Disease

OCT Angiography Fractal Analysis of Choroidal Neovessels Secondary to Central Serous Chorioretinopathy, in a Caucasian Cohort

InCASEOf scoring system for distinction between pachychoroid-associated macular neovascularization and neovascular age-related macular degeneration in patients older than 50 years

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