Polypoidal Choroidal Vasculopathy: Evaluation Based on 3-Dimensional Reconstruction of OCT Angiography

Kelvin Y C Teo; Jin Zhi Zhao; Gerd Klose; Won Ki Lee; Chui Ming Gemmy Cheung

doi:10.1016/j.oret.2023.11.001

Polypoidal Choroidal Vasculopathy: Evaluation Based on 3-Dimensional Reconstruction of OCT Angiography

Ophthalmol Retina. 2024 Feb;8(2):98-107. doi: 10.1016/j.oret.2023.11.001. Epub 2023 Nov 11.

Authors

Kelvin Y C Teo¹, Jin Zhi Zhao², Gerd Klose³, Won Ki Lee⁴, Chui Ming Gemmy Cheung⁵

Affiliations

¹ Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore; The University of Sydney, Save Sight Institute, Sydney Medical School, Sydney, NSW, Australia. Electronic address: gmstyck@nus.edu.sg.
² Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
³ Carl Zeiss Meditec, Inc., Dublin, California.
⁴ Nune Eye Hospital, Seoul, South Korea.
⁵ Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore. Electronic address: gemmy.chueng.c.m@singhealth.com.sg.

PMID: 37956793
DOI: 10.1016/j.oret.2023.11.001

Abstract

Objective: Three-dimensional (3D) reconstruction using swept-source OCT angiography (SS-OCTA) can provide insights into the nature and structure of polypoidal choroidal vasculopathy (PCV) and its component parts, the polypoidal lesion (PL) and the branching neovascular network (BNN). This study aims to describe novel observations of PCV using 3D reconstruction of SS-OCTA, and to compare these observations with similar images of type I macular neovascularization (MNV) typical neovascular age-related macular degeneration (nAMD).

Design: Clinical case series.

Subjects: Patients with PCV in either eye from clinical studies conducted in a tertiary retina center.

Methods: Images with prespecified SS-OCTA imaging protocol were obtained and reconstructed in 3D. Forty neovascularization lesions (30 PCV and 10 typical nAMD) based on SS-OCTA were analyzed.

Main outcome measures: The following 3 specific features were evaluated: (1) the pattern of flow signal within the PLs as either homogenous or showing internal vascular architecture; (2) the configuration of the BNN as hypermature, mature, or immature; and (3) the spatial arrangement of the PLs in relation to the BNN. Comparisons were made between PCV and typical nAMD.

Results: All PLs exhibited internal vascular architecture in the form of coil-like loops and none exhibited homogenous flow. Small focal nodules were present within this internal vascular architecture in 70% of PLs. Branching neovascular networks exhibited a hypermature/mature configuration (100 vs. 50%, P < 0.01) and were associated with thicker choroid compared with typical nAMD type 1 MNV (238.7 ± 104.3 vs. 155.6 ± 49.2, P = 0.02). The BNN and PL were located at distinct anteroposterior planes in 81% of the eyes.

Conclusions: We identified proliferating vasculature in both the PL and the BNN. Comparison of the configuration suggests that the BNN represents a more chronic and inactive lesion than the PL.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Keywords: ICGA; Neovascular age-related macular degeneration; OCTA; PCV; Polypoidal lesion.

MeSH terms

Choroid* / pathology
Choroidal Neovascularization* / diagnosis
Choroidal Neovascularization* / pathology
Fluorescein Angiography / methods
Humans
Polypoidal Choroidal Vasculopathy
Tomography, Optical Coherence / methods