scholarly journals The implications of subretinal fluid in pachychoroid neovasculopathy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Geun Woo Lee ◽  
Hyeon Cheol Roh ◽  
Se Woong Kang ◽  
A. Young Kim ◽  
Hoon Noh ◽  
...  
Keyword(s):  
Central Serous Chorioretinopathy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Multimodal Imaging ◽  
Optical Coherence Tomography Angiography ◽  
Subretinal Fluid ◽  
Longitudinal Changes ◽  
History Of ◽  
Pachychoroid Neovasculopathy ◽  
Choroidal Vasculopathy ◽  
Epidemiological Parameters

AbstractThis study aimed to identify the clinical characteristics and longitudinal changes in exudative pachychoroid neovasculopathy (PNV) and non-exudative PNV. This retrospective cohort study involved 81 eyes of PNV diagnosed by multimodal imaging including optical coherence tomography angiography. At baseline, they were divided into exudative PNV group and non-exudative PNV group depending on the presence of subretinal fluid. The clinical features of both groups and the longitudinal changes were investigated and compared. There were 55 eyes with non-exudative PNV and 26 eyes with exudative PNV. Individuals with non-exudative PNV were older, more frequently asymptomatic and had a higher prevalence of polypoidal choroidal vasculopathy in the opposite eye (all P’s < 0.05). Whereas individuals with exudative PNV showed thicker choroid and more frequent history of central serous chorioretinopathy (all P’s < 0.001). During about 12 months of longitudinal observation, the transformation into polypoidal choroidal vasculopathy was noted in 4 eyes of non-exudative PNV group, whereas in none of the exudative PNV group. Exudative PNV and non-exudative PNV seem to be separate entities with different epidemiological parameters. Non-exudative PNV, which is frequently found without symptoms at an older age, is suspected to be the significant precursor lesion of polypoidal choroidal vasculopathy. In contrast, exudative PNV may share the same pathophysiology as central serous chorioretinopathy.

Epidemiology, Prevalence And Incidence in Pachychoroid Disease Spectrum

2020 ◽  
pp. 57-91
Keyword(s):  
Risk Factors ◽  
Central Serous Chorioretinopathy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Disease Spectrum ◽  
Focal Choroidal Excavation ◽  
Pachychoroid Neovasculopathy ◽  
Novel Concept ◽  
Pathogenic Process ◽  
Choroidal Vasculopathy ◽  
Pachychoroid Pigment Epitheliopathy

Pachychoroid is a relatively novel concept describing a phenotype characterized by increased choroidal thickening, pathologically dilated veins in the Haller’s layer (pachy-veins), thinning in Sattler’s and choriocapillaris layers. The spectrum comprises the following disease groups: Pachychoroid Pigment Epitheliopathy, Central Serous Chorioretinopathy, Pachychoroid Neovasculopathy, Polypoidal Choroidal Vasculopathy, Focal choroidal excavation, Peripapillary pachychoroid syndrome. These conditions all exhibit the characteristic choroidal alterations and are believed to represent different manifestations of a common pathogenic process. The aim of this review is to exhibit the epidemiology, risk factors, incidence and prevalence of the pachychoroid diseases respectively.

scholarly journals Clinical features of pachyvessels associated with polypoidal choroidal vasculopathy in chronic central serous chorioretinopathy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Te-An Wang ◽  
Wei-Chun Chan ◽  
Shawn H. Tsai ◽  
Lee-Jen Chen
Keyword(s):  
Clinical Features ◽  
Combination Treatment ◽  
Central Serous Chorioretinopathy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Subretinal Fluid ◽  
Chronic Central Serous Chorioretinopathy ◽  
Disease Remission ◽  
Anti Vegf ◽  
The Mean ◽  
Choroidal Vasculopathy

AbstractTo investigate the association between clinical features of chronic central serous chorioretinopathy (CSC) and subsequent development of polypoidal choroidal vasculopathy (PCV). Characteristics and treatment response of PCV secondary to CSC were described. This retrospective observational study included 18 patients with chronic CSC (18 eyes) with subsequent PCV and 36 controls (36 eyes) with chronic CSC without PCV development during follow-up. Clinical features were compared between the two groups. A logistic regression model was used to evaluate the risk factor of PCV formation. Treatments for PCV included anti-vascular endothelial growth factor (VEGF) monotherapy, photodynamic therapy (PDT), or PDT and anti-VEGF combination treatment. Subretinal fluid on optical coherence tomography images were assessed after treatments. Significant between-group differences were observed in best-corrected visual acuity after disease resolution and presence of pachyvessels (P = .001 and P = .003, respectively). The presence of pachyvessels in chronic CSC was associated with subsequent PCV (odds ratio = 6.00; 95% CI, 1.74–20.68; P = .005). CSC recurrence and subfoveal choroidal thickness (SFCT) were not significantly associated with subsequent PCV development (P = .393 and P = .911, respectively). The mean age of PCV diagnosis was 51 years, and the mean time from CSC diagnosis to PCV confirmation was 77.8 months. The mean (range) SFCT of PCV was 327.7 (134–599) μm. Nine patients received anti-VEGF monotherapy and 5 had disease remission. Four patients received PDT and anti-VEGF combination treatment and all of the 4 had disease remission. In chronic CSC, pachyvessel characteristics are associated with subsequent PCV development. This result will assist clinicians to evaluate CSC in clinical practice and provide insights into the pathogenesis of PCV.

Pachychoroid Pigment Epitheliopathy; Signs, Diagnosis, and Management

2020 ◽  
pp. 93-97
Keyword(s):  
Central Serous Chorioretinopathy ◽  
Subretinal Fluid ◽  
Ancient Greek ◽  
Diagnosis And Management ◽  
Current Review ◽  
History Of ◽  
Pachychoroid Neovasculopathy ◽  
Pachychoroid Pigment Epitheliopathy

Pachychoroid (ancient Greek pachy: thick) means thick choroid. Pachychoroid pigment epitheliopathy (PPE) has been recently defined as a forme fruste of central serous chorioretinopathy (CSC). Its characteristic findings are pachychoroid phenotype, a variety of RPE abnormalities, absence of subretinal fluid, and absence of a history of subretinal fluid. PPE may progress to CSC or pachychoroid neovasculopathy. The aim of the current review is to provide an overview of signs, diagnosis, and management of PPE.

scholarly journals Eplerenone in the Treatment of Polypoidal Choroidal Vasculopathy

2015 ◽  
Vol 6 (3) ◽  
pp. 477-481 ◽  
Author(s):  
Kapil G. Kapoor ◽  
Alan L. Wagner
Keyword(s):  
Central Serous Chorioretinopathy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Mineralocorticoid Receptor ◽  
Subretinal Fluid ◽  
Mineralocorticoid Receptor Antagonists ◽  
Receptor Antagonists ◽  
First Case ◽  
Choroidal Vasculopathy

Overactivation of mineralocorticoid receptor pathways has been implicated in the pathophysiology of central serous chorioretinopathy (CSCR). Recently, mineralocorticoid receptor antagonists such as eplerenone have demonstrated success in treating subretinal fluid in CSCR. This case demonstrates a patient who was initially presumed to have subretinal fluid secondary to CSCR and was started on a trial of oral eplerenone. It quickly became evident that her subretinal fluid was secondary to a peripapillary polypoidal choroidal vasculopathy network, but she demonstrated a significant improvement with oral eplerenone. To the authors' knowledge, this is the first case of eplerenone use to treat polypoidal choroidal vasculopathy.

scholarly journals Polypoidal choroidal vasculopathy in pachychoroid: combined treatment with photodynamic therapy and Aflibercept

2021 ◽  
Author(s):  
Maria Vadalà ◽  
Massimo Castellucci ◽  
Giulia Guarrasi ◽  
Giovanni Cillino ◽  
Vincenza Maria Elena Bonfiglio ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Photodynamic Therapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Combined Therapy ◽  
Combined Treatment ◽  
Subretinal Fluid ◽  
Clinical Activity ◽  
Monthly Basis ◽  
Choroidal Vasculopathy

Abstract Introduction To evaluate the effects of combined therapy using intravitreal Aflibercept (IVA) and photodynamic therapy (PDT) on polypoidal choroidal vasculopathy related to pachychoroid disease (PPCV).Methods Patients with PPCV were treated with PDT combined with 3 IVA injections on a monthly basis, followed by pro re nata criteria. The 12-month follow-up consisted of multiple revaluations of visual acuity and SSOCT parameters of clinical activity.Results Nineteen eyes were included in the study; mean age was 65.5 years. Visual acuity improved after 12 months (0.35 ± 0.25 to 0.2 ± 0.20 logMAR, p = 0.005). Percentage of eyes with intraretinal and subretinal fluid reduced from baseline to the 12-month follow-up (from 52.6–10.5%, p = 0.12, and from 89.5–5.3% p = 0.0009, respectively). Central retinal and mean macular thicknesses reduced (258 ± 39.6 to 204.8 ± 38.8 µm p = 0.04 and 293.8 ± 32.1 to 248.1 ± 29.6 µm p = 0.017 respectively). Central choroidal and mean choroidal thicknesses also displayed a reduction (328.6 ± 54.9 to 289.8 ± 44.6 µm p = 0.001 and 314.5 ± 55.3 to 287.9 ± 47.6 µm p = 0.015 respectively). The mean number of injections was 4.6/year.Conclusion The results support the use of a combined therapy with Aflibercept and PDT in PPCV. This treatment would act in synergy, with anti-VEGF controlling exudation and PDT closing the aneurysmal vessel and reducing choroidal congestion.

Dark and white lesions observed in central serous chorioretinopathy on optical coherence tomography angiography

2018 ◽  
Vol 28 (4) ◽  
pp. 446-453 ◽  
Author(s):  
Flore De Bats ◽  
Pierre-Loïc Cornut ◽  
Benjamin Wolff ◽  
Laurent Kodjikian ◽  
Martine Mauget-Faÿsse
Keyword(s):  
Optical Coherence Tomography ◽  
Central Serous Chorioretinopathy ◽  
Multimodal Imaging ◽  
Optical Coherence Tomography Angiography ◽  
Pigment Epithelium ◽  
Serous Retinal Detachment ◽  
Descriptive Study ◽  
Dark Spot ◽  
Optical Coherence ◽  
Choroidal Neovascular Membrane

Purpose: To describe abnormal dark (hyposignal) and white (hypersignal) lesions observed on optical coherence tomography angiography in central serous chorioretinopathy. Methods: Prospective, multicenter, and descriptive study including patients with active or quiescent central serous chorioretinopathy. All patients had undergone a complete ophthalmic examination. Results: Abnormal dark lesions were detected as “dark spots” and “dark areas” on optical coherence tomography angiography. A “dark spot” could correspond to six different abnormalities: pigment epithelium detachment, subretinal deposit, “Lucency” within surrounding subretinal fibrin, choroidal cavitation, choroidal excavation, and choroidal fluid. A “dark area” could be related to a serous retinal detachment or choriocapillary compression. Abnormal white lesions were also detected: A “white spot” could correspond with the leaking point on fluorescein angiography or with hyper-reflective dots; A “white filamentous pattern” at the Brüch’s membrane level corresponded to abnormal choroidal neovascular vessels. Conclusion: A semiology is described using optical coherence tomography angiography in central serous chorioretinopathy as abnormal dark and white lesions. Multimodal imaging is mandatory in addition to optical coherence tomography angiography to diagnose non-neovascular retinal and choroidal central serous chorioretinopathy lesions. However, optical coherence tomography angiography alone is helpful in detecting choroidal neovascular membrane in central serous chorioretinopathy.

scholarly journals Noninvasive multimodal imaging in diagnosing polypoidal choroidal vasculopathy

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jingyuan Yang ◽  
Mingzhen Yuan ◽  
Erqian Wang ◽  
Song Xia ◽  
Youxin Chen
Keyword(s):  
Polypoidal Choroidal Vasculopathy ◽  
Multimodal Imaging ◽  
High Sensitivity ◽  
Age Related Macular Degeneration ◽  
Fundus Photography ◽  
Diagnostic Strategy ◽  
Imaging Features ◽  
Imaging Methods ◽  
Age Related ◽  
Choroidal Vasculopathy

Abstract Purpose To investigate the diagnostic accuracy of noninvasive multimodal imaging methods in diagnosing polypoidal choroidal vasculopathy (PCV) and distinguishing PCV from typical neovascular age-related macular degeneration (nvAMD). Methods Retrospective study. Imaging features of noninvasive multimodal imaging methods, including fundus photography (FP), B-scan optical coherence tomography (OCT), en face OCT, OCT angiography, and autofluorescence, of 103 eyes with PCV or typical nvAMD were reviewed. Diagnostic strategy was established based on imaging features and was validated in other 105 eyes with PCV or typical nvAMD. Results Features of subretinal orange nodule on FP, thumb-like PED on OCT, notched PED on OCT, bubble sign on OCT, and Bruch’s membrane depression under serosanguinous PED on OCT were more common. When the diagnostic strategy of using at least 2 of 5 features was performed, there is 0.88 sensitivity and 0.92 specificity for diagnosing PCV. The results of the validation test further confirmed the diagnostic strategy with 0.94 sensitivity and 0.93 specificity. Conclusions Noninvasive multimodal imaging, especially FP and B-scan OCT, provide high sensitivity and specificity for diagnosing PCV and distinguishing PCV from typical nvAMD, when at least 2 of 5 suggestive imaging features are present.

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