Vortex vein anastomosis and pachychoroid—an evolving understanding

Sharma, Ashish; Parachuri, Nikulaa; Kumar, Nilesh; Bandello, Francesco; Kuppermann, Baruch D.; Loewenstein, Anat; Regillo, Carl D.; Chakravarthy, Usha

doi:10.1038/s41433-021-01423-2

Cited by 6 publications

(4 citation statements)

References 18 publications

(29 reference statements)

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“…Indeed, longstanding choroidal venous congestion would be very characteristic of pachychoroid disease and might be a background of its development. 31,32 Spaide et al described vascular choroidal flow as an analogous to that of cerebral venous circulation and underlined the potential resistance role of ocular vortex veins. 6 Thus, in attempt to compensate for longstanding choroidal congestion, new drainage routes would appear leading vortex vein anastomosis (VVA) development.…”

Section: Discussionmentioning

confidence: 99%

Choroidal features in non-neovascular and neovascular pachychoroid diseases

Hachicha,

Bouraoui,

El Matri

et al. 2023

European Journal of Ophthalmology

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Purpose To evaluate choroidal findings on multimodal imaging in eyes within pachychoroid spectrum diseases and to compare quantitative and qualitative choroidal features between non-neovascular (NNV-PDS) and neovascular (NV-PDS) pachychoroid diseases Methods Retrospective cross-sectional study comparing between NV-PDS and NNV-PDS. All patients underwent multimodal imaging including infracyanine green angiography (IFCGA) and swept source optical coherence tomography (OCT) and angiography (OCT-A). The following parameters were analyzed: subfoveal choroidal thickness (SFCT), choroidal vascular index (CVI), presence of pachyvessels and choroidal vascular interconnections (CVIC), presence of choroidal neovascularization and choriocapillaris density. Results Of the 87 eyes included in the study, 63 eyes (73%) had NNV-PDS and 24 eyes (27%) had NV-PDS. Mean SFCT and CVI were significantly higher in NNV-PDS group (p = 0.01; p = 0.022). Pachyvessels were more diffusely distributed in NNV-PD group and more focally distributed in NV-PDS group (p = 0.029). CVIC were more frequently noted in NV-PDS group (p = 0.024). A higher CVI was associated to a thicker choroid (p < 0.001), with significant negative correlations between the presence of CVIC and both SFCT (p = 0.015) and CVI (p = 0.002). We also observed a lower choriocapillaris vascular density and higher number of choriocapillaris flow voids in eyes with NNV-PDS (p = 0.24; p = 0.61). Conclusion NNV-PDS eyes had a significantly thicker SFCT, higher CVI and a lower rate of detected CVIC than eyes with NV-PDS. These highlighted choroidal vascular changes might lead to a better understanding of pachychoroid disease pathophysiology. More frequently observed in NV-PDS group, CVIC are believed to assess the development of vortex vein anastomoses as a remodelling process for vascular decongestion.

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Section: Discussionmentioning

confidence: 99%

Choroidal features in non-neovascular and neovascular pachychoroid diseases

Hachicha,

Bouraoui,

El Matri

et al. 2023

European Journal of Ophthalmology

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“…Recently, some authors 19 have highlighted the inaccuracy of the SFCT as a diagnostic criterion for pachychoroid disorders and have deflected the attention from choroidal thickness to the choroidal circulation itself. Intriguingly, several recent studies 26 – 30 have postulated that choroidal vortex vein congestion and subsequent formation of intervortex venous anastomoses might have an integral role in the pathogenesis of pachychoroid. 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.…”

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

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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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“…The exact etiology of pachychoroid disease is unknown, but recent evidence using wide-field ICGA and OCT suggested that it is related to the formation of intervortex venous anastomosis at the watershed area in the posterior pole [ 10 – 12 ]. Intervortex venous anastomosis is more commonly seen in patients with pachychoroid diseases than in normal individuals [ 10 ].…”

Section: Pachychoroid Diseasementioning

confidence: 99%

The Contemporary Role of Photodynamic Therapy in the Treatment of Pachychoroid Diseases

Chan

et al. 2021

Journal of Ophthalmology

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Recent advances in retinal imaging technology have improved our understanding in the pathogenesis and evolvement of various chorioretinal diseases. Central serous chorioretinopathy and polypoidal choroidal vasculopathy are now recognized to belong to the same spectrum of disorders known as pachychoroid diseases. Pachychoroid diseases have similar pathogenesis pathway and common characteristics of thickened choroid, dilated outer choroidal vessels, and thinning of choriocapillaris. More disease entities have been identified to belong to this disease spectrum. Photodynamic therapy can induce choroidal hypoperfusion, remodeling of abnormal choroidal vessels, and reduction of choroidal congestion. It is known to be an effective treatment for chronic central serous chorioretinopathy and polypoidal choroidal vasculopathy. Many new studies are being performed to investigate its efficacy in other pachychoroid diseases. In this review, we provided an overview of the rationale, efficacy, and treatment strategies of photodynamic therapy in different pachychoroid diseases and discussed its role in the management along with other treatment modalities with most updated clinical evidence.

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Vortex vein anastomosis and pachychoroid—an evolving understanding

Cited by 6 publications

References 18 publications

Choroidal features in non-neovascular and neovascular pachychoroid diseases

Choroidal features in non-neovascular and neovascular pachychoroid diseases

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

The Contemporary Role of Photodynamic Therapy in the Treatment of Pachychoroid Diseases

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