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Original Investigation
December 2017

Optical Coherence Tomography Angiography for Assessment of the 3-Dimensional Structures of Polypoidal Choroidal Vasculopathy

Author Affiliations
  • 1Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
  • 2Department of Ophthalmology and School of Medicine, National Taiwan University, Taipei
  • 3Department of Ophthalmology and School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
JAMA Ophthalmol. 2017;135(12):1310-1316. doi:10.1001/jamaophthalmol.2017.4360
Key Points

Question  What is the 3-dimensional anatomy of polypoidal complexes in polypoidal choroidal vasculopathy?

Findings  In this cohort study of 47 patients with polypoidal choroidal vasculopathy, optical coherence tomography angiography quantitatively demonstrated polypoidal complexes in 36.2% (polypoidal structures) and 55.3% (branching vascular networks). Branching vascular networks and vessels sprouting from the choriocapillaris level were arranged in a 3-dimensional architecture, with polypoidal structures within the inner part of the level of the retinal pigment epithelium reference plane, the branching vascular networks on the outer side of the retinal pigment epithelium reference plane, and a stalk even farther out into the choroidal level.

Meaning  These findings suggest that optical coherence tomography angiography identifies quantitative 3-dimensional structures of polypoidal lesions that may help understanding of the pathogenesis of polypoidal choroidal vasculopathy.

Abstract

Importance  Investigating the quantitative 3-dimensional (3-D) anatomy of polypoidal complex is important for a better understanding of the pathogenesis of polypoidal choroidal vasculopathy (PCV).

Objective  To quantitatively evaluate the 3-D characteristics of polypoidal structures, branching vascular networks (BVNs), and origin of PCV using optical coherence tomography angiography (OCTA) and multiple image systems.

Design, Setting, and Participants  A prospective, observational study was conducted in 47 consecutive Taiwanese patients (47 eyes) from May 21, 2015, to April 30, 2017. All participants were scanned with the Optovue-RTVue-XR-Avanti OCTA system. Patients in whom PCV was identified on OCTA were examined to define characteristics and structures of the original spouting vessels (stalks) from the choroid, polypoidal structures, and BVNs on OCTA.

Main Outcomes and Measures  Quantitative analysis of 3-D structures of the polypoidal complex.

Results  Among the 47 patients, the mean (SD) patient age was 68.9 (8.0) years, and 28 (59.6%) men were included. Clear images of polypoidal structures could be detected in 17 eyes (36.2%, 22 polypoidal structures), BVNs in 26 eyes (55.3%, 26 tufts of BVNs), and stalks of origin from the choroid in 26 eyes (55.3%, 26 stalks) on the en face plane on OCTA. All polypoidal structures were found at a mean (SD) height of 45.3 (36.1) μm above the retinal pigment epithelium (RPE) reference plane that was preset by the machine, while the BVNs were found at a mean (SD) depth of 28.6 (14.2) μm below the RPE reference plane and the choroidal stalks at 80.4 (24.4) μm below RPE reference plane. The mean (SD) thickness of polypoidal structures was 38.4 (15.5) μm and of BVNs, 60.2 (25.0) μm. The polypoidal structures were all above the Bruch membrane within the dome of the RPE detachment, the choroidal stalks were all in the choroid layer. The BVNs could be either above (up to 18 μm), within, or below (up to 28 μm) the Bruch membrane and were in proximity to the double layers of flattened RPE detachment.

Conclusions and Relevance  These results demonstrate a 3-D architecture of PCV that may be helpful for a better understanding of the anatomy, pathophysiology, and pathogenesis of PCV.

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