scholarly journals Choroidal caverns in pachychoroid neovasculopathy

2021 ◽  
Vol 6 (6-1) ◽  
pp. 237-243
Author(s):  
E. K. Pedanova
Keyword(s):  
Pigment Epithelium ◽  
Diagnostic Techniques ◽  
Posterior Pole ◽  
Age Related Macular Degeneration ◽  
Oct Angiography ◽  
Age Related ◽  
Retinal Pathology ◽  
En Face Oct ◽  
En Face ◽  
Pachychoroid Neovasculopathy

Background. Choroid plays an important role in the pathogenesis of retinal pathology. Choroidal cavern, a recently identifi ed fi nding of optical coherent tomography (OCT), has been described in some degenerative and atrophic forms of retinal pathology. In the literature, there are only a few studies of choroidal cavers in pachychoroid neovasculopathy, newly described form of age related macular degeneration.The aim: to perform a detailed analysis of choroidal structure on OCT scans of patients with pachychoroid neovasculopathy and to reveal the frequency of choroidal caverns identifi cation.Material and methods. The data of 30 patients (30 eyes) aged 64.4 ± 5.6 years with pachychoroid neovascularization were retrospectively analyzed. The patients underwent spectral OCT and OCT-angiography (OCTA) using a Spectralis device (Heidelberg Engineering, Germany). The protocol was “Posterior Pole”, consisting of 61 scans. To assess the structure of the choroid, an enhanced image depth (EDI) module was used. OCT angiography was performed with a scan area of 6 × 6 mm. These methods were compared to identify choroidal caverns.Results. On OCT subretinal type 1 neovascularization was revealed as a fl at detachment of the pigment epithelium and visualization of blood flow on OCTA in the lesion as angled vessels (21 eyes) or a seafan (9 eyes). On OCT-EDI scans, there was diffuse or local choroidal thickening of choroid with an increase in the vessels of the Haller’s layer and thinning of the choriocapillaries. Choroidal caverns appeared on OCT and en-face OCT as areas with low optical density, round or irregular, located in different layers of the chorioid, without hyperrefl ective boundaries. A typical sign of choroidal cavern is the tail of hypertransmission after the cavern toward the sclera. Choroidal caverns were found in 4 of 30 eyes (13.3 %) and were located both near the choroidal neovascularization lesion and beyond this area.Conclusion. The prevalence of choroidal cavities, a new choroidal biomarker, in pachychoroid neovasculopathy was 13.3 %. Identification of these changes is possible with the use of modern diagnostic techniques (OCT-EDI, OCTA and en-face OCT) that allow visualization the state of the choroid. The prognostic signifi cance of choroidal cavities requires further study.

scholarly journals Pachychoroid Neovasculopathy Disguising as Age-Related Macular Degeneration Treated by Spironolactone and Anti-VEGF Combination Therapy

2021 ◽  
pp. 116-123
Author(s):  
Leonie F. Keidel ◽  
Benedikt Schworm ◽  
Siegfried G. Priglinger ◽  
Jakob Siedlecki
Keyword(s):  
Combination Therapy ◽  
Macular Degeneration ◽  
Pigment Epithelium ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Chronic Central Serous Chorioretinopathy ◽  
Anti Vegf ◽  
Age Related ◽  
Therapeutic Concepts ◽  
Pachychoroid Neovasculopathy

Nonresponse of neovascular age-related macular degeneration (nAMD) to anti-vascular endothelial growth factor (anti-VEGF) therapy can often be attributed to misdiagnosis, and pathologies mimicking AMD might require different therapeutic concepts. In the following, we want to outline a case of presumed nAMD which revealed to be pachychoroid neovasculopathy (PNV) and was successfully treated by the addition of spironolactone. A 67-year-old female patient was referred for nonresponse of nAMD on her left eye after 29 intravitreal injections of aflibercept with no complete resolution of subretinal fluid. On fundoscopy, both maculae presented with pigment epithelium alterations, while the left eye showed subretinal fluid on optical coherence tomography (OCT) with an associated pigment epithelium detachment, which revealed to contain a neovascular network on OCT angiography. There was faint leakage on fluorescence (FAG) and indocyanine green angiography (ICGA) and some focal vascular dilation of the neovascular network on ICGA. Due to the absence of Drusen on any eye, a thick choroid, and the presence of a gravitational tract on blue autofluorescence (BAF), chronic central serous chorioretinopathy with a choroidal neovascularization, defined as PNV in the pachychoroid disease was diagnosed. Upon the addition of spironolactone to anti-VEGF treatment, choroidal thickness significantly decreased, and subretinal fluid resolution was observed and maintained for the first time. In conclusion, PNV should be ruled out in cases of presumed nAMD nonresponding to anti-VEGF. In these cases, a combination therapy of anti-VEGF and mineralocorticoid antagonists can facilitate fluid resorption.

Pachychoroid Neovasculopathy; Findings, Diagnosis, and Treatment

2020 ◽  
pp. 112-117
Keyword(s):  
Optical Coherence Tomography ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Current Treatment ◽  
Age Related Macular Degeneration ◽  
Optical Coherence ◽  
Age Related ◽  
Pachychoroid Neovasculopathy ◽  
Sign Type

Pachychoroid neovasculopathy (PNV) is a novel clinical entity with typical pachychoroid features accompanied by type 1 choroidal neovascularization (CNV). Typical optical coherence tomography finding of the disease is flat irregular pigment epithelial detachments (double layer sign). Type 1 CNV between retinal pigment epithelium and Bruch membrane is seen as a tangled network on optical coherence tomography angiography. Differential diagnosis of PNV from neovascular age-related macular degeneration is especially important because of the different epidemiological, genetic, and therapeutic features of these diseases. Current treatment approaches include intravitreal anti-vascular endothelial growth factor injections and photodynamic therapy.

Modern Imaging Techniques for Visualising Choroidal Morphology and Function

2021 ◽  
Vol 238 (09) ◽  
pp. 951-961
Author(s):  
Marion Munk ◽  
Chantal Dysli
Keyword(s):  
Inflammatory Diseases ◽  
Imaging Techniques ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Diagnostic Techniques ◽  
Age Related Macular Degeneration ◽  
Basic Knowledge ◽  
Pathologic Myopia ◽  
Age Related ◽  
And Function

AbstractThe choroid is directly adjacent to the retina and consists of a dense vascular network that supplies the outer retina. Pathologies in the choroid can lead to changes in the retinal pigment epithelium (RPE) and photoreceptors. Thus, the choroid plays a crucial role in the development of retinal diseases such as age-related macular degeneration (AMD), central serous chorioretinopathy (CSCR), pathologic myopia, and inflammatory diseases such as Vogt-Koyanagi-Harada syndrome (VKH). Basic knowledge of the structure and physiology of the choroid, as well as diagnostic options for visualizing choroidal changes, provides a better understanding of the physiology and pathology of choroidal processes. This review provides an overview of the anatomy and function of the choroid, and describes the diagnostic techniques currently available to characterize and visualize the choroid. It also includes an overview of various retinal conditions, which are associated with choroidal changes.

scholarly journals Small choroidal melanoma and pseudomelanomas: methods of differential diagnostics (literature review). Part 2

2020 ◽  
Vol 13 (2) ◽  
pp. 88-98
Author(s):  
E. B. Myakoshina
Keyword(s):  
Literature Review ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Choroidal Melanoma ◽  
Metastatic Carcinoma ◽  
Posterior Pole ◽  
Age Related Macular Degeneration ◽  
Fluorescence Angiography ◽  
Differential Diagnostics ◽  
Age Related

The first part of the literature review described the ophthalmoscopic picture of the small choroidal melanoma and pseudomelanomas [ROJ, 2019; 12 (4): 99–108]. This is the second part of the review, which describes the features characteristic of small uveal melanoma and pseudomelanomas, revealed by fluorescence angiography and autofluorescence. Typical properties of fluorescence and autofluorescence are presented for every disease of the eye fundus studied: small choroidal melanoma, choroidal nevus, circumscribed choroidal hemangioma, melanocytoma, choroidal metastatic carcinoma, congenital hypertrophy of the retinal pigment epithelium, late-stage age-related macular degeneration, focal retinochoroiditis of the posterior pole, organized subretinal hemorrhage, retinal hemangioma. The attention was focused on the similarity of angiographic and autofluorescence symptoms of the diseases under study. The need for new differential diagnostic criteria was emphasized.

Quantification of Early and Intermediate Age-related Macular Degeneration Using OCT “en face” Presentation

2021 ◽  
Author(s):  
Frauke Jürgens ◽  
Kai Rothaus ◽  
Henrik Faatz ◽  
Britta Heimes-Bussmann ◽  
Daniel Pauleikhoff ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Macular Degeneration ◽  
Retinal Pigment ◽  
Age Related Macular Degeneration ◽  
Fundus Photography ◽  
Slice Thickness ◽  
Age Related ◽  
En Face Oct ◽  
En Face ◽  
The Impact

Abstract Background Early and intermediate age-related macular degeneration (AMD) results in drusen deposits under the retinal pigment epithelium (RPE). These early stages of AMD exhibit different risks of progressing to late AMD. To date, early AMD has been classified and quantified by fundus photography. This does not appear to be sensitive enough for clinical trials studying the impact on drusen. SD-OCT with two-dimensional rendering of the segmented slices analysed allows for en face imaging of the drusen. The present trial studied the potential of quantifying early and intermediate AMD by en-face optical coherence tomography (OCT). Material and Methods Thirty-one eyes of 29 patients in different stages of early and intermediate AMD were studied. To this end, fundus photographs (Kowa VX-10i, Kowa, Tokyo, Japan) and en-face OCT images (RTVue XR Avanti, Optovue, Inc., Fremont, CA, USA) were taken. First, different segmentation levels (6 µm underneath the RPE, on the RPE, 6 µm and 9 µm above the RPE) and different layer thicknesses (5 µm, 10 µm, 20 µm and 30 µm) were analysed to determine the best segmentation for visualising drusen. Drusen were marked manually and their number and surface area calculated. This analysis was then compared with the standardised drusen analyses on fundus photography. Additional changes in early and intermediate AMD such as pigment epithelial detachments (PEDs) and subretinal drusenoid deposits (SDD) as well as small atrophies were also documented and compared. Outcomes The best segmentation for delineating the drusen on the en-face OCT images was found to be a segmentation 6 µm underneath the RPE with a slice thickness of 20 µm. Comparison of drusen quantification on en-face OCT images with the standardised drusen analysis on fundus photography revealed particularly good similarity. Other changes in early and intermediate AMD, such as PEDs, SDD and small atrophies, were easier to assess on the en-face OCT images. Conclusions The analysis and quantification of drusen from en-face OCT images with 20 µm segmentation at 6 µm underneath the RPE allows differentiated quantification of various drusen characteristics. Moreover, other changes in early and intermediate AMD can also be analysed. In future observational and clinical trials, this could help quantify drusen.

scholarly journals A Method for En Face OCT Imaging of Subretinal Fluid in Age-Related Macular Degeneration

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Fatimah Mohammad ◽  
Justin Wanek ◽  
Ruth Zelkha ◽  
Jennifer I. Lim ◽  
Judy Chen ◽  
...  
Keyword(s):  
Healthy Subject ◽  
Macular Degeneration ◽  
Retinal Pigment ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Retinal Layer ◽  
Age Related ◽  
En Face Oct ◽  
En Face ◽  
Oct Imaging

Purpose. The purpose of the study is to report a method for en face imaging of subretinal fluid (SRF) due to age-related macular degeneration (AMD) based on spectral domain optical coherence tomography (SDOCT).Methods. High density SDOCT imaging was performed at two visits in 4 subjects with neovascular AMD and one healthy subject. En face OCT images of a retinal layer anterior to the retinal pigment epithelium were generated. Validity, repeatability, and utility of the method were established.Results. En face OCT images generated by manual and automatic segmentation were nearly indistinguishable and displayed similar regions of SRF. En face OCT images displayed uniform intensities and similar retinal vascular patterns in a healthy subject, while the size and appearance of a hypopigmented fibrotic scar in an AMD subject were similar at 2 visits. In AMD subjects, dark regions on en face OCT images corresponded to reduced or absent light reflectance due to SRF. On en face OCT images, a decrease in SRF areas with treatment was demonstrated and this corresponded with a reduction in the central subfield retinal thickness.Conclusion. En face OCT imaging is a promising tool for visualization and monitoring of SRF area due to disease progression and treatment.

scholarly journals Non-Invasive Diagnosis of Polypoidal Choroidal Vasculopathy as a Variant of the Course of Age-Related Macular Degeneration

2018 ◽  
Vol 15 (2S) ◽  
pp. 273-280 ◽  
Author(s):  
I. E. Panova ◽  
T. B. Shaimov ◽  
V. A. Shaimova
Keyword(s):  
Indocyanine Green ◽  
Macular Degeneration ◽  
Polypoidal Choroidal Vasculopathy ◽  
Indocyanine Green Angiography ◽  
Pigment Epithelium ◽  
Clinical Signs ◽  
Age Related Macular Degeneration ◽  
Oct Angiography ◽  
Age Related ◽  
Choroidal Vasculopathy

Purpose: to study noninvasive diagnostic options for polypoidal choroidal vasculopathy (PCV) — a subtype of neovascular agerelated macular degeneration — by monitoring clinical progression, defining optical coherence tomography (OCT) findings specific for PCV and evaluating diagnostic utility of OCT angiography.Patients and methods. The study included 254 patients (292 eyes) with neovascular age-related macular degeneration. All patients underwent complex eye examination: visual acuity test, slit lamp biomicroscopy, ophthalmoscopy with 60 and 78D fundus lenses, fundoscopy with color filters, spectral-domain OCT, OCT angiography and biometry. Fluorescein angiography was performed in 66 cases. Indocyanine green angiography was employed in 16 patients with PCV. All statistical analyses were performed with IBM SPSS Statistics 19 software package.Results. In 14 of 16 patients (87.5%) indocyanine green angiography revealed round hyperfluorescent lesions which corresponded to ophthalmoscopy findings — subretinal reddish orange nodules localized primarily in the parafovea. In 11 cases (68.8%) the nodules were associated with hemorrhage and in 14 cases (87.5%) — with hard yellowish exudates. Comparative analysis of retinal anatomy allowed for defining typical OCT signs of PCV that distinguish the clinical entity from type 1 and 2 choroidal neovascular membranes: neurosensory retinal detachment in the parafovea (80.0%, p < 0.001) and hard exudates (71.9%, p < 0.001). OCT findings characteristic of PCV are dome-shaped pigment epithelium detachment (100%), bubble sign (94.74%), notch sign (68.4%) and double layer sign (92.9%).Conclusion. Noninvasive diagnosis of polypoidal choroidal vasculopathy should encompass clinical signs, fundoscopy findings, OCT-based morphometry and OCT angiography criteria. OCT angiography has high diagnostic value and enables detection of branching vascular network and polypoidal formations. 

scholarly journals En Face OCT Imaging for the Diagnosis of Outer Retinal Tubulations in Age-Related Macular Degeneration

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Benjamin Wolff ◽  
Alexandre Matet ◽  
Vivien Vasseur ◽  
José-Alain Sahel ◽  
Martine Mauget-Faÿsse
Keyword(s):  
Macular Degeneration ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
Spectral Domain ◽  
Macular Disease ◽  
Spectral Domain Oct ◽  
Age Related ◽  
En Face Oct ◽  
En Face ◽  
Oct Imaging

Purpose. “En face” is an emerging imaging technique derived from spectral domain optical coherence tomography (OCT). It produces frontal sections of retinal layers, also called “C-scan OCT.” Outer retinal tubulations (ORTs) in age-related macular degeneration (AMD) are a recent finding evidenced by spectral-domain OCT. The aim of this study is to characterize the morphology of ORT according to the form of AMD, using “en-face” spectral domain OCT.Methods. “En face” OCT imaging was prospectively performed in 26 consecutive eyes with AMD that also had ORT.Results. There were 15 neovascular, 8 atrophic, and 3 eyes with a mixed (fibrotic and atrophic) form of AMD. Among the neovascular group, the most frequent tubulation pattern on “en-face” OCT was a branching network emanating from a fibrovascular scar; we term this pattern as “pseudodendritic.” It did not require treatment when observed as an isolated finding. In all cases of atrophic AMD, the tubular network was located at the edge of the geographic atrophy area, and formed a “perilesional” pattern. Six atrophic cases showed tubular invaginations inside this area.Conclusion. “En face” OCT is a valuable technique in the diagnosis and followup of macular disease. It revealed the main characteristic patterns of ORT associated with neovascular and atrophic AMD.

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