Evaluating Polypoidal Choroidal Vasculopathy With Optical Coherence Tomography Angiography

Min Wang, Yao Zhou, Simon S Gao, Wei Liu, Yongheng Huang, David Huang, Yali Jia, Min Wang, Yao Zhou, Simon S Gao, Wei Liu, Yongheng Huang, David Huang, Yali Jia

Abstract

Purpose: We observed and analyzed the morphologic characteristics of polypoidal lesions and abnormal branching vascular network (BVN) in patients with polypoidal choroidal vasculopathy (PCV) by optical coherence tomography angiography (OCTA).

Methods: A retrospective observational case series was done of patients with PCV. All patients were scanned with a 70-kHz spectral-domain OCT system using the split-spectrum amplitude-decorrelation angiography (SSADA) algorithm to distinguish blood flow from static tissue. The OCTA images of these patients were compared to those from indocyanine green angiography (ICGA). Semiautomated segmentation was used to further analyze the polypoidal lesion and the BVN.

Results: We studied 13 eyes of 13 patients 51 to 69 years old. A total of 11 patients were treatment-naive. Two patients had multiple anti-VEGF injections and one underwent photodynamic therapy (PDT). Optical coherence tomography angiography was able to detect the BVN in all cases. Using cross-sectional OCTA, BVN locations were shown to be in the space between the RPE and Bruch's membrane. Using en face OCTA, the BVN vascular pattern could be shown more clearly than by ICGA. Polypoidal lesions showed high flow signals in different patterns in 12 cases in the outer retina slab. Using cross-sectional OCTA, the polyps were shown to be just below the top of the pigment epithelial detachment (PED). In one case, the polypoidal lesion was not detectable at the outer retina slab.

Conclusions: Optical coherence tomography angiography is a noninvasive imaging tool for detecting vascular changes in PCV. Branching vascular networks showed more clearly on OCTA than on ICGA. Polypoidal lesions had variable patterns on OCTA and were not always detected. The OCTA patterns of the polypoidal lesions and the BVN are helpful in understanding the pathology of PCV.

Figures

Figure 1
Figure 1
Multi-modal imaging of patient 11. (A) The fundus photograph shows orange-red polypoidal lesions (red arrow). (B) Early-phase ICGA shows polyps and BVN. (C) Spectral-domain OCT scans corresponding to the interrupted white lines in (B) identify PED (red arrow, cross-section 1 on top) and BVN (white arrow, cross-section 2 on bottom). (D) 3 × 3 mm macular en face OCTA of the outer retina reference. The high flow signal spots (red arrow) indicates the location of the polyps. (E) Enlarged ICGA (yellow rectangle in [B]) shows polyps (red arrows) and BVN. (F) 3 × 3 mm en face OCTA of the macula shows BVN (white-dotted line enclosure). (G) Color composite en face OCTA shows BVN flow (yellow outer retinal flow) in the context of normal retinal circulation (purple inner retinal flow). (H) Color composite cross-sectional OCTA shows that the BVN was in the space between RPE and Bruch's membrane (white arrow, cross-section 1 on top) and the polyps were just below the top of the PED (red arrow, cross-section 2 on bottom). (I) En face OCTA of the slab from outer boundary of OPL to BM shows polyps (red arrows) and BVN (white dotted line enclosure) clearly at the same time.
Figure 2
Figure 2
Multi-modal imaging of patient 10. (A) Fundus photography shows a large orange-red lesion (red arrow) (B) Early-phase ICGA shows the polyps as a hyper-fluorescent nodule surrounded by the hypo-fluorescent pool. The BVN is on the right side of the polyps. (C) The cross-sectional OCT crossing polyps (interrupted white line on [B]) identifies dome-shaped PED (red arrow) and BVN (white arrow). Hyperreflective signal under the top of PED can be observed. (D) 3 × 3 mm en face OCTA with the outer retina slab identifies the polyps (red arrow). The flow signals show as white spots with half-circle. (E) The yellow rectangle in (B) was enlarged for better comparison with OCTA. (F) 3 × 3 mm en face OCTA with the choroid capillary reference plane shows the BVN (white-dotted line enclosure). (G) Color composite en face OCTA identifies the polyps (red arrow) and BVN (white-dotted line enclosure). Signals of polyps show as high flow spots with a half-circle. (H) Color composite cross-sectional OCTA shows that the signals of polyps (red arrow) were just below the top of PED and the signals of the BVN (white arrow) were in the space between the RPE and Bruch's membrane.
Figure 3
Figure 3
Comparison of the polyps with different vascular patterns by OCTA and ICGA. Optical coherence tomography angiography (A1) and ICGA (A2) of patient 3. Optical coherence tomography angiography with the outer retina slab shows the signals of the polyps as a circle (red dotted line enclosure). Early-phase ICGA shows a large hyperfluorescent nodule (red dotted line enclosure). Optical coherence tomography angiography (B1) and ICGA (B2) of patient 13. Optical coherence tomography angiography with the outer retina slab shows the signals of the polyps as some spots (red dotted line enclosure). Late phase ICGA shows corresponding polyps (red dotted line enclosure). Optical coherence tomography angiography (C1) and ICGA (C2) of patient 5. Optical coherence tomography angiography with the outer retina slab shows polyps as a cluster of high flow signals (red dotted line enclosure). Early-phase ICGA shows the corresponding polyps (red dotted line enclosure). Optical coherence tomography angiography (D1) and ICGA (D2) of patient 12. Optical coherence tomography angiography with the outer retina slab can not detect the flow signal at the location the polyps should be (red dotted line enclosure). Early-phase ICGA shows polyps as a hyperfluorescent spot (red dotted line enclosure).
Figure 4
Figure 4
Color composite cross-sectional OCTA of four patients. Color composite cross-sectional OCTA of patients 2 (A) and 4 (B) show the signal of polyps (yellow signals). Signals of the polyps are just below the top of the PED (red arrows). Color composite cross-sectional OCTA of patients 12 (C) and 1 (D) show the signal of BVN (yellow signals). Signals of the BVN are in the space between the RPE and Bruch's membrane (white arrows).
Figure 5
Figure 5
Comparison of the BVN with different vascular patterns by OCTA and ICGA. Optical coherence tomography angiography (A1) and ICGA (A2) from patient 6. Optical coherence tomography angiography with the choroid capillary slab shows the BVN with seafan pattern more clearly than ICGA (yellow dotted line enclosure). Early-phase ICGA shows the BVN (yellow dotted line enclosure). Optical coherence tomography angiography (B1) and ICGA (B2) from patient 3. Optical coherence tomography angiography with the choroid capillary slab shows feeder vessel and draining vessel (yellow arrows). Early-phase ICGA shows corresponding feeder vessel and draining vessel (yellow arrows). Polyps on ICGA shows more obvious than OCTA. Optical coherence tomography angiography (C1) and ICGA (C2) from patient 1. Optical coherence tomography angiography with the choroid capillary slab shows the BVN with medusa pattern more clearly than ICGA (yellow dotted line enclosure). Early-phase ICGA shows the BVN (yellow dotted line enclosure). Optical coherence tomography angiography (D1) and ICGA (D2) from case 8. Optical coherence tomography angiography with the choroid capillary slab shows the BVN with a tangle pattern more clearly than ICGA (yellow dotted line enclosure. Early-phase ICGA shows unclear BVN (yellow dotted line enclosure).

References

    1. Yannuzzi LA,, Sorenson J,, Spaide RF,, et al. Idiopathic polypoidal choroidal vasculopathy (IPCV). Retina. 1990. ; 10: 1–8.
    1. Kikuchi M,, Nakamura M,, Ishikawa K,, et al. Elevated C-reactive protein levels in patients with polypoidal choroidal vasculopathy and patients with neovascular age-related macular degeneration. Ophthalmology. 2007. ; 114: 1722–1727.
    1. Laude A,, Cackett PD,, Vithana EN,, et al. Polypoidal choroidal vasculopathy and neovascular age-related macular degeneration: same or different disease? Prog Retin Eye Res. 2010. ; 29: 19–29.
    1. Japanese Study Group of Polypoidal Choroidal Vasculopathy. Criteria for diagnosis of polypoidal choroidal vasculopathy [in Japanese]. Nippon Ganka Gakkai Zasshi. 2005; 109: 417–427.
    1. Benya R,, Quintana J,, Brundage B. Adverse reactions to indocyanine green: a case report and a review of the literature. Cathet Cardiovasc Diagn. 1989. ; 17: 231–233.
    1. Hope-Ross M,, Yannuzzi LA,, Gragoudas ES,, et al. Adverse reactions due to indocyanine green. Ophthalmology. 1994. ; 101: 529–533.
    1. Sato T,, Kishi S,, Watanabe G,, Matsumoto H,, Mukai R. Tomographic features of branching vascular networks in polypoidal choroidal vasculopathy. Retina. 2007. ; 27: 589–594.
    1. Jia Y,, Tan O,, Tokayer J,, et al. Split-spectrum amplitude-decorrelation angiography with optical coherence tomography. Opt Express. 2012. ; 20: 4710–4725.
    1. Jia Y,, Bailey ST,, Wilson DJ,, et al. Quantitative optical coherence tomography angiography of choroidal neovascularization in age-related macular degeneration. Ophthalmology. 2014. ; 121: 1435–1444.
    1. El AA,, Cohen SY,, Semoun O,, et al. Type2 neovascularization secondary to age-related macular degeneration imaged by optical coherence tomography angiography. Retina. 2015. ; 35: 2212–2218.
    1. Huang D,, Jia Y,, Rispoli M,, Tan O,, Lumbroso B. Optical coherence tomography angiography of time course of choroidal neovascularization in response to anti-vascular treatment. Retina. 2015. ; 35: 2260–2264.
    1. Lumbroso B,, Rispoli M,, Savastano MC. Longitudinal optical coherence tomography angiography study type 2 naïve choroidal neovascularization early response after treatment. Retina. 2015. ; 35: 2242–2251.
    1. Gao SS,, Liu G,, Huang D,, Jia Y. Optimization of the split-spectrum amplitude-decorrelation angiography algorithm on a spectral optical coherence tomography system. Opt Lett. 2015. ; 40: 2305–2308.
    1. Kraus MF,, Liu JJ,, Schottenhamml J,, et al. Quantitative 3D-OCT motion correction with tilt and illumination correction, robust similarity measure and regularization. Biomed Opt Express. 2014. ; 5: 2591–2613.
    1. Tan O,, Li G,, Lu AT,, Varma R,, Huang D. Mapping of macular substructures with optical coherence tomography for glaucoma diagnosis. Ophthalmology. 2008. ; 115: 949–956.
    1. Kim JY,, Kwon OW,, Oh HS,, Kim SH,, You YS. Optical coherence tomography angiography in patients with polypoidal choroidal vasculopathy [published online ahead of print November 30 2015]. Graefes Arch Clin Exp Ophthalmol. doi:.
    1. Inoue M,, Balaratnasingam C,, Freund KB. Optical coherence tomography angiography of polypoidal choroidal vasculopathy and polypoidal choroidal neovascularization. Retina. 2015. ; 35: 2265–2274.
    1. Srour M,, Querques G,, Semoun O,, et al. Optical coherence tomography angiography characteristics of polypoidal choroidal vasculopathy [published online ahead of print February 2, 2016]. Br J Ophthalmol. doi:.
    1. Yuzawa M,, Mori R,, Kawamura A. The origins of polypoidal choroidal vasculopathy. Br J Ophthalmol. 2005. ; 89: 602–607.
    1. Alshahrani ST,, Al SH,, Kahtani ES,, Ghazi NG. Spectral-domain optical coherence tomography findings in polypoidal choroidal vasculopathy suggest a type 1 neovascular growth pattern. Clin Ophthalmol. 2014. ; 8: 1689–1695.
    1. Khan S,, Engelbert M,, Imamura Y,, Freund KB. Polypoidal choroidal vasculopathy: simultaneous indocyanine green angiography and eye-tracked spectral domain optical coherence tomography findings. Retina. 2012. ; 32: 1057–1068.
    1. Kuehlewein L,, Bansal M,, Lenis TL,, et al. Optical coherence tomography angiography of type 1 neovascularization in age-related macular degeneration. Am J Ophthalmol. 2015; 160: 739–748.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere