Visualising the choriocapillaris: Histology, imaging modalities and clinical research ‐ A review

Ng, Danny Siu-Chun; Chan, Leo Ka Yu; Ng, Ching Man; Lai, Timothy Y. Y.

doi:10.1111/ceo.13984

Cited by 6 publications

(2 citation statements)

References 73 publications

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“…The choriocapillaris, in particular, has been found to consist of a tightly packed meshwork of capillaries surrounded by many intercapillary spaces that exhibit physiologic and pathologic changes with age, myopia, hypertension, and various other diseases. 16,17 In this context, it is important to realize that the overall size and thickness of the choroid is determined by changes in any of the above-mentioned structures, and not only those in its vascular component. For years, point choroidal thickness has been used as a marker of vascular change in the choroid in a variety of systemic and ocular disorders.…”

Section: Discussionmentioning

confidence: 99%

Optical Coherence Tomography Angiography Reveals Paradoxically Decreasing Choroidal Thickness and Increasing Blood Flow in Remitting Vogt–koyanagi–harada Syndrome

Fayed

Gerges²

2022

Retina

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Purpose: To assess changes in choroidal thickness and blood flow in active Vogt-Koyanagi-Harada syndrome and after remission using optical coherence tomography angiography.Methods: This was a prospective study of patients with active early uveitis secondary to Vogt-Koyanagi-Harada syndrome. They underwent optical coherence tomography angiography imaging twice: at baseline and after remission on treatment. 3-• 3-and 6-• 6-mm choriocapillaris slabs were used to evaluate parafoveal adjusted flow index as a marker for choroidal blood flow. Mean choroidal thickness of 3 points (subfoveally and 2 points 300 mm parafoveally) was also measured.Results: Thirty-nine eyes of 25 patients were initially recruited. After excluding eyes with media opacity, submacular fibrosis, and choroidal neovascularization, 23 eyes of 14 patients were included. The mean follow-up period was 8.7 ± 2.5 months. Mean choroidal thickness in activity and remission was 581.65 ± 108.29 mm and 318.34 ± 72.85 mm respectively (P , 0.01). Mean adjusted flow index in the 3-• 3-mm slabs activity and remission were 0.495 ± 0.027 and 0.519 ± 0.0336 (P = 0.011), and the 6-• 6-mm slabs were 0.487 ± 0.037 and 0.517 ± 0.052 respectively (P = 0.025). Conclusion:We demonstrate decreasing choroidal thickness with paradoxically increasing choroidal flow on optical coherence tomography angiography in remitting Vogt-Koyanagi-Harada syndrome. This may reflect inflammatory infiltrations or granulomas increasing choroidal thickness during activity and causing sluggish circulation of the choriocapillaris, and a reversal of this process with remission. These findings shed more light on the relationship between Vogt Koyanagi Harada syndrome and its underlying choroidal disturbances. Larger studies are needed to evaluate the efficacy of adjusted flow index in evaluating and predicting disease activity.

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Section: Discussionmentioning

confidence: 99%

Optical Coherence Tomography Angiography Reveals Paradoxically Decreasing Choroidal Thickness and Increasing Blood Flow in Remitting Vogt–koyanagi–harada Syndrome

Fayed

Gerges²

2022

Retina

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“…OCTA is a more recently developed technology which allows for detection of erythrocyte motion without the need of an intravascular dye, thereby providing high-resolution images of the retinal and choroidal vasculatures. 54,55 A number of studies have evaluated the use of OCTA for diagnosing PCV and there appeared to be a wide range of diagnostic accuracy for diagnosing various features of PCV. This is likely due to variations in OCTA analysis protocols and devices, as well as intrinsic factors of the PCV eyes affecting the detection rates.…”

Section: Optical Coherence Tomography Angiography (Octa)mentioning

confidence: 99%

Polypoidal Choroidal Vasculopathy: Updates on Risk Factors, Diagnosis, and Treatments

Ruamviboonsuk

Cheung

Chainakul

et al. 2023

Asia-Pacific Journal of Ophthalmology

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There have been recent advances in basic research and clinical studies in polypoidal choroidal vasculopathy (PCV). A recent, large-scale, population-based study found systemic factors, such as male gender and smoking, were associated with PCV, and a recent systematic review reported plasma C-reactive protein, a systemic biomarker, was associated with PCV. Growing evidence points to an association between pachydrusen, recently proposed extracellular deposits associated with the thick choroid, and the risk of development of PCV. Many recent studies on diagnosis of PCV have focused on applying criteria from noninvasive multimodal retinal imaging without requirement of indocyanine green angiography. There have been attempts to develop deep learning models, a recent subset of artificial intelligence, for detecting PCV from different types of retinal imaging modality. Some of these deep learning models were found to have high performance when they were trained and tested on color retinal images with corresponding images from optical coherence tomography. The treatment of PCV is either a combination therapy using verteporfin photodynamic therapy and anti-vascular endothelial growth factor (VEGF), or anti-VEGF monotherapy, often used with a treat-and-extend regimen. New anti-VEGF agents may provide more durable treatment with similar efficacy, compared with existing anti-VEGF agents. It is not known if they can induce greater closure of polypoidal lesions, in which case, combination therapy may still be a mainstay. Recent evidence supports long-term follow-up of patients with PCV after treatment for early detection of recurrence, particularly in patients with incomplete closure of polypoidal lesions.

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Diurnal changes in choroidal optical coherence tomography angiography indices over 24 hours in healthy young adults

Lal

Alonso‐Caneiro

Read

et al. 2023

Sci Rep

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This prospective study investigated the magnitude and pattern of variation in choroidal optical coherence tomography angiography (OCT-A) indices every 4 h over 24 h in healthy young myopic (n = 24) and non-myopic (n = 20) adults. Choriocapillaris and deep choroid en-face images from macular OCT-A scans were analysed from each session to extract magnification-corrected vascular indices including choriocapillaris flow deficit number, size and density and deep choroid perfusion density in the sub-foveal, sub-parafoveal, and sub-perifoveal regions. Choroidal thickness was also obtained from structural OCT scans. Significant variations over 24 h (P < 0.05) were observed in most of the choroidal OCT-A indices excluding sub-perifoveal flow deficit number, with peaks observed between 2 to 6 AM. For myopes, peaks occurred significantly earlier (3–5 h), and the diurnal amplitude was significantly greater for sub-foveal flow deficit density (P = 0.02) and deep choroidal perfusion density (P = 0.03) compared with non-myopes. Choroidal thickness also showed significant diurnal changes (P < 0.05) with peaks between 2 to 4 AM. Significant correlations were found between diurnal amplitudes or acrophases of choroidal OCT-A indices and choroidal thickness, intraocular pressure, and systemic blood pressure. This provides the first comprehensive diurnal assessment of choroidal OCT-A indices over 24 h.

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Visualising the choriocapillaris: Histology, imaging modalities and clinical research ‐ A review

Cited by 6 publications

References 73 publications

Optical Coherence Tomography Angiography Reveals Paradoxically Decreasing Choroidal Thickness and Increasing Blood Flow in Remitting Vogt–koyanagi–harada Syndrome

Optical Coherence Tomography Angiography Reveals Paradoxically Decreasing Choroidal Thickness and Increasing Blood Flow in Remitting Vogt–koyanagi–harada Syndrome

Polypoidal Choroidal Vasculopathy: Updates on Risk Factors, Diagnosis, and Treatments

Diurnal changes in choroidal optical coherence tomography angiography indices over 24 hours in healthy young adults

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