Ophthalmic Surgery, Lasers and Imaging Retina

Clinical Science 

Characteristics of Polypoidal Choroidal Vasculopathy Evaluated by Multispectral Imaging

Jie Zhang, MD; Yan Yan, MD; Zikui Yu, MD; Lin Liu, MD

Abstract

BACKGROUND AND OBJECTIVE:

To analyze the morphological and pathological characteristics of polypoidal choroidal vasculopathy (PCV) on multispectral imaging (MSI).

PATIENTS AND METHODS:

This prospective study included patients with a clinical diagnosis of treatment-naive PCV. All patients underwent a complete ophthalmological examination including fundus photography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), and MSI. MSI was obtained by digital multispectral ophthalmoscope, which allows the visualization of retinal and choroidal structures progressively. The characteristics of PCV on MSI were analyzed and compared with ICGA.

RESULTS:

Sixteen eyes of 14 patients (mean age 60.9 years ± 9.2 years; 11 male and three female) were included for analysis. Polypoidal lesions were detected in 15 eyes (93.8%) by MSI with nodular or nebulous hyperreflectance on choroidal oxy-deoxy map. MSI was able to reveal all the branching vascular networks (BVNs) detected by ICGA. Retinal pigment epithelial atrophy with melanin stacking was found with MSI infrared wavelengths around pigment epithelial detachment (PED) and in areas above the BVNs in 13 eyes (81.3%). The sensitivity and specificity of MSI were 93.8% and 100%, respectively, for identifying typical PCV with both BVN and polypoidal lesions.

CONCLUSION:

MSI appears to be a promising modality for detecting noninvasively the vascular and structural changes in PCV, especially for BVN. MSI may also be used to monitor the metabolic and functional changes of retinal pigment epithelium secondary to polypoidal lesions.

[Ophthalmic Surg Lasers Imaging Retina. 2018;49:e249–e255.]

Abstract

BACKGROUND AND OBJECTIVE:

To analyze the morphological and pathological characteristics of polypoidal choroidal vasculopathy (PCV) on multispectral imaging (MSI).

PATIENTS AND METHODS:

This prospective study included patients with a clinical diagnosis of treatment-naive PCV. All patients underwent a complete ophthalmological examination including fundus photography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), and MSI. MSI was obtained by digital multispectral ophthalmoscope, which allows the visualization of retinal and choroidal structures progressively. The characteristics of PCV on MSI were analyzed and compared with ICGA.

RESULTS:

Sixteen eyes of 14 patients (mean age 60.9 years ± 9.2 years; 11 male and three female) were included for analysis. Polypoidal lesions were detected in 15 eyes (93.8%) by MSI with nodular or nebulous hyperreflectance on choroidal oxy-deoxy map. MSI was able to reveal all the branching vascular networks (BVNs) detected by ICGA. Retinal pigment epithelial atrophy with melanin stacking was found with MSI infrared wavelengths around pigment epithelial detachment (PED) and in areas above the BVNs in 13 eyes (81.3%). The sensitivity and specificity of MSI were 93.8% and 100%, respectively, for identifying typical PCV with both BVN and polypoidal lesions.

CONCLUSION:

MSI appears to be a promising modality for detecting noninvasively the vascular and structural changes in PCV, especially for BVN. MSI may also be used to monitor the metabolic and functional changes of retinal pigment epithelium secondary to polypoidal lesions.

[Ophthalmic Surg Lasers Imaging Retina. 2018;49:e249–e255.]

Introduction

Polypoidal choroidal vasculopathy (PCV) is a disorder characterized by a branching vascular network (BVN) in the choroidal vasculature and polypoidal lesions under the retinal pigment epithelium (RPE). As first described by Yannuzzi et al. in 1990, PCV is a distinct clinical entity that differs from neovascular age-related macular degeneration (nAMD) both clinically and demographically.1 Patients with PCV are younger and more likely Asian compared to patients with nAMD, and they mainly present with multiple serous or hemorrhagic pigment epithelial detachment (PED) instead of drusen.2 This key feature of PCV is associated with the presence of BVN and choroidal polyps, which can also cause recurrent episodes of exudative retinal detachment, subretinal hemorrhage, and subretinal exudation.1–3

Although the diagnosis of PCV is based on ophthalmoscopic identification of subretinal reddish-orange polyp-like structure,1 comprehensive imaging modalities are needed for better understanding of the morphological changes beneath the RPE and in choroidal vasculature. Indocyanine green angiography (ICGA) is considered the best tool to detect BVN and polyps.4 Optical coherence tomography (OCT) can help observe PED, which is characterized by dome-like elevations of RPE or “double-layer sign,” which indicates the area of BVN.5

Multispectral imaging (MSI) is a novel technology that can visualize chorioretinal vasculature without intravenous dye injection.6 MSI can also detect RPE atrophy and melanin stacking secondary to chorioretinal abnormal lesions.7–9

In this study, we described imaging features of PCV using MSI and compared them with the angiographic features on ICGA. We also evaluated the morphological changes such as PED and metabolic changes of RPE on MSI and compared them with manifestations on FFA.

Patients and Methods

In this prospective study, all participants were recruited from the Department of Ophthalmology at Renji Hospital of Jiaotong University, Shanghai, China, from May 2014 to December 2016. The study was approved by our local ethics committee and was conducted in accordance with the ethical standards stated in the 1964 Declaration of Helsinki.

All patients underwent a comprehensive ophthalmologic examination including medical history, best-corrected visual acuity (BCVA), slit-lamp examination, fundus photography, OCT (Cirrus HD-OCT 4000; Carl Zeiss Meditec AG, Oberkochen, Germany), fundus fluorescein angiography (FFA), ICGA (Spectralis HRA+OCT; Heidelberg Engineering, Heidelberg, Germany), and MSI (Annidis, Ottawa, Canada). Two retinal specialists (ZJ, YY) reviewed all medical data and made the diagnosis of PCV. Eyes with poor-quality MSI images due to cataract or poor fixation were excluded from the study.

MSI was obtained by Annidis RHA instrument, which uses a modified fundus camera with 10 monochromatic, discrete light-emitting diodes (LEDs) as illuminants. These LEDs cover 10 wavelengths ranging from 550 nm (green) to 850 nm (near-infrared) and create a series of en face fundus spectral sections throughout the whole thickness of the retina and choroid.10 By combining wavelengths that interact with oxygenated hemoglobin, the RHA system enhances the visualization of complex vasculature that overlays the RPE and choroid, known as oxy-deoxy map.11 Within the map, areas with a relatively higher percentage of oxyhemoglobin will appear brighter than those with a lower percentage. Therefore, retinal or choroidal vasculature can be well-outlined and easily interpreted by clinicians.

The MSI characteristics of PCV were analyzed and compared with ICGA. The abilities to detect polypoidal lesions, BVN, and RPE pathology by using MSI were assessed by two experienced readers (LL, ZY).

Results

Demographic and clinical characteristics of patients with PCV are shown in the Table. We studied 16 eyes of 14 patients (11 male, three female), aged from 42 to 77 years (mean 60.9 years ± 9.2 years). All eyes were naive to treatment. Mean BCVA was 0.63 logMAR ± 0.44 logMAR. In one eye, type 2 choroidal neovascularization (CNV) was detected in association with PCV.

Clinical Characteristics of Patients With PCV and Their ICGA and MSI Findings

Table 1:

Clinical Characteristics of Patients With PCV and Their ICGA and MSI Findings

The polypoidal lesions were detected in 16 eyes (100%) by ICGA and in 15 eyes (93.8%) by MSI, which revealed these lesions as hyperreflective structures (white in appearance) on choroidal oxy-deoxy maps (marked by yellow arrowheads, Figures 1 to 4). Compared with early phase ICGA images, these hyperreflective areas topographically corresponded to polyps visualized on ICGA. The patterns of the polypoidal lesions on MSI showed as nodular (13 eyes) (Figures 1 and 2) or as nebulous (two eyes) (Figures 3 and 4).

Multimodal imaging of the right eye of a 42-year-old man. (A) Color fundus photograph. (B) Early phase fundus fluorescein angiography (FFA) shows large areas of window defects at posterior pole. (C) Early-phase indocyanine green (ICG) angiography shows the branching vascular networks (BVNs) (yellow arrow) and the polypoidal lesions (yellow arrowheads). (D) Cirrus HD-OCT 4000 (Carl Zeiss Meditec AG, Oberkochen, Germany) shows double-layer sign. (E) Multispectral imaging (MSI) 740 nm shows retinal pigment epithelium atrophy with melanin stacking corresponding to early phase FFA image. (F) MSI oxy-deoxy map of choroid shows the BVNs (yellow arrow) and nodular hyperreflectance (yellow arrowheads) corresponding to the polypoidal lesions in early phase ICG angiogram.

Figure 1.

Multimodal imaging of the right eye of a 42-year-old man. (A) Color fundus photograph. (B) Early phase fundus fluorescein angiography (FFA) shows large areas of window defects at posterior pole. (C) Early-phase indocyanine green (ICG) angiography shows the branching vascular networks (BVNs) (yellow arrow) and the polypoidal lesions (yellow arrowheads). (D) Cirrus HD-OCT 4000 (Carl Zeiss Meditec AG, Oberkochen, Germany) shows double-layer sign. (E) Multispectral imaging (MSI) 740 nm shows retinal pigment epithelium atrophy with melanin stacking corresponding to early phase FFA image. (F) MSI oxy-deoxy map of choroid shows the BVNs (yellow arrow) and nodular hyperreflectance (yellow arrowheads) corresponding to the polypoidal lesions in early phase ICG angiogram.

Multimodal imaging of the left eye of a 52-year-old man with polypoidal choroidal vasculopathy and associated type 2 choroidal neovascularization (CNV). (A) Color fundus photograph shows a large orange-red lesion (white arrow). (B) Early phase fundus fluorescein angiography (FFA) shows window defects temporal to the optic disc and areas above the branching vascular networks (BVNs). (C) Early phase indocyanine green (ICG) angiography shows the BVNs (yellow arrow) terminating in the big polypoidal lesion (yellow arrowhead). (D) Cirrus HD-OCT 4000 (Carl Zeiss Meditec AG, Oberkochen, Germany) shows nodular hyperreflectance above retinal pigment epithelium (RPE) indicating type 2 CNV. (E) Multispectral imaging (MSI) 760 nm shows RPE atrophy with melanin stacking corresponding to early-phase FFA image. (F) MSI oxy-deoxy map of choroid shows the BVNs (yellow arrow) and nodular hyperreflectance (yellow arrowhead) corresponding to the polypoidal lesion in early phase ICG angiogram.

Figure 2.

Multimodal imaging of the left eye of a 52-year-old man with polypoidal choroidal vasculopathy and associated type 2 choroidal neovascularization (CNV). (A) Color fundus photograph shows a large orange-red lesion (white arrow). (B) Early phase fundus fluorescein angiography (FFA) shows window defects temporal to the optic disc and areas above the branching vascular networks (BVNs). (C) Early phase indocyanine green (ICG) angiography shows the BVNs (yellow arrow) terminating in the big polypoidal lesion (yellow arrowhead). (D) Cirrus HD-OCT 4000 (Carl Zeiss Meditec AG, Oberkochen, Germany) shows nodular hyperreflectance above retinal pigment epithelium (RPE) indicating type 2 CNV. (E) Multispectral imaging (MSI) 760 nm shows RPE atrophy with melanin stacking corresponding to early-phase FFA image. (F) MSI oxy-deoxy map of choroid shows the BVNs (yellow arrow) and nodular hyperreflectance (yellow arrowhead) corresponding to the polypoidal lesion in early phase ICG angiogram.

Multimodal imaging of the left eye of a 52-year-old man. (A) Color fundus photograph. (B) Early phase fundus fluorescein angiography (FFA) shows subretinal hemorrhages around polypoidal lesions and window defects temporal to macula. (C) Early phase indocyanine green angiography shows the branching vascular networks (BVNs) (yellow arrow) and polypoidal lesions (yellow arrowhead). (D) Cirrus HD-OCT 4000 (Carl Zeiss Meditec AG, Oberkochen, Germany) shows dome-shaped pigment epithelial detachment (PED). (E) Multispectral imaging (MSI) 760 nm shows oval-shaped PED with hyporeflectance in the center and hyperreflectance on the boundaries. (F) MSI oxy-deoxy map of choroid shows the BVNs (yellow arrow) and nebulous hyperreflectance (yellow arrowhead) due to the large PED overlaying the relatively small polyps.

Figure 3.

Multimodal imaging of the left eye of a 52-year-old man. (A) Color fundus photograph. (B) Early phase fundus fluorescein angiography (FFA) shows subretinal hemorrhages around polypoidal lesions and window defects temporal to macula. (C) Early phase indocyanine green angiography shows the branching vascular networks (BVNs) (yellow arrow) and polypoidal lesions (yellow arrowhead). (D) Cirrus HD-OCT 4000 (Carl Zeiss Meditec AG, Oberkochen, Germany) shows dome-shaped pigment epithelial detachment (PED). (E) Multispectral imaging (MSI) 760 nm shows oval-shaped PED with hyporeflectance in the center and hyperreflectance on the boundaries. (F) MSI oxy-deoxy map of choroid shows the BVNs (yellow arrow) and nebulous hyperreflectance (yellow arrowhead) due to the large PED overlaying the relatively small polyps.

Multimodal imaging of the left eye of a 66-year-old man. (A) Color fundus photograph shows the orange subretinal nodule superior-temporal to the macular. (B) Early phase fundus fluorescein angiography (FFA) shows large window defects at posterior pole. (C) Early phase indocyanine green angiography shows the branching vascular networks (BVNs) (yellow arrow) and polypoidal lesions (yellow arrowheads). (D) Cirrus HD-OCT 4000 (Carl Zeiss Meditec AG, Oberkochen, Germany) shows the disordered and bulged retinal pigment epithelium (RPE). (E) Multispectral imaging (MSI) 760 nm shows RPE atrophy with melanin stacking corresponding to early phase FFA image. (F) MSI oxy-deoxy map shows the BVNs (yellow arrow) and nebulous hyperreflectance (yellow arrowheads).

Figure 4.

Multimodal imaging of the left eye of a 66-year-old man. (A) Color fundus photograph shows the orange subretinal nodule superior-temporal to the macular. (B) Early phase fundus fluorescein angiography (FFA) shows large window defects at posterior pole. (C) Early phase indocyanine green angiography shows the branching vascular networks (BVNs) (yellow arrow) and polypoidal lesions (yellow arrowheads). (D) Cirrus HD-OCT 4000 (Carl Zeiss Meditec AG, Oberkochen, Germany) shows the disordered and bulged retinal pigment epithelium (RPE). (E) Multispectral imaging (MSI) 760 nm shows RPE atrophy with melanin stacking corresponding to early phase FFA image. (F) MSI oxy-deoxy map shows the BVNs (yellow arrow) and nebulous hyperreflectance (yellow arrowheads).

All of the BVNs detected by ICGA were revealed by MSI, as well. The en face contours of the choroidal vessels were well-observed from MSI oxy-deoxy maps, and the BVNs showed as abnormally dilated or tangled vascular network, which had hyperreflectance same as early phase ICG angiogram (marked by yellow arrows, Figures 1 to 4).

RPE atrophy with melanin stacking was found around PED and in areas above the BVNs in 13 eyes (81.3%) by using MSI infrared wavelengths (especially 760 nm and 780 nm). RPE atrophy appeared as hyperreflective areas, whereas melanin stacking had no reflectance and appeared dark on MSI images through all longer wavelengths (marked by dashed frames, Figures 1, 2, and 4) due to high absorption of spectral light by melanin pigment. In addition, single or multiple PEDs were visualized on MSI in 12 eyes (75%) as round or oval-shaped structures with hyporeflectance in the center and hyperreflectance on the boundaries. Compared with late-phase FFA, this ring-like feature topographically corresponded to PED detected by FFA. However, PED had mid to hyperreflectance on choroidal oxy-deoxy map, and we found it was hard in a few cases to differentiate small polyps from big PED areas (Figures 3 and 4).

Comparison between MSI and ICGA showed that sensitivity of MSI was 100% for vascular network and 93.8% for polyps, with 100% specificity.

Discussion

MSI is a new, noninvasive imaging technique that allows the visualization of retinal and choroidal structures progressively by employing multiple wavelength LED sources, ranging from the visible to near infrared.12 Recent MSI studies showed its capability in detecting major pathological changes in central serous chorioretinopathy (CSCR), retinal vein occlusion, and RPE-related fundus diseases.7–9,13 Our current study mainly focused on the applications of MSI oxy-deoxy map, analyzing the imaging characteristics of PCV with MSI and comparing them with the angiographic features on ICGA and FFA.

Polyps are rich in oxygenated blood because of their pathological feature described as focal, arterial, aneurysmal dilation and its connection with choroidal microvascular network.14,15 As a result, in all patients, the polypoidal lesions were hyperreflective on MSI choroidal oxy-deoxy maps. We previously described the nodular areas with hyperreflectance indicating polypoidal lesions on MSI in a PCV case.6 In this study, we further confirmed this type of feature by analyzing more clinical data. Meanwhile, another pattern of polypoidal lesion shown on MSI oxy-deoxy maps, which we described as “nebulous,” was discovered in two eyes. Compared with the nodular pattern, this type of lesion also appeared hyperreflective but had a less-defined boundary. This could be caused by PED overlying the relatively small polyps, and together they showed hyperreflectance with blurred edges. Another reason is that some polyps could be supplied by interconnecting vessels, which is a less common type of BVN.16 Due to the hyperreflective background of these crisscrossing choroidal vessels, polyps that sit in between were hard to be differentiated. In such cases, MSI may fail to reveal the polypoidal lesions independently as ICGA and only show the combination of abnormal structures.

As for the visualization of the BVNs, we demonstrated that MSI choroidal oxy-deoxy map had the same detection rate as ICGA, and choroidal vasculature viewed from MSI highly corresponded with ICG angiogram. Compared with optical coherence tomography angiography (OCTA), which is also a noninvasive imaging tool for retinal or choroidal vasculature, MSI gives a more direct view similar to ICG angiogram. The MSI oxy-deoxy map enhances the information of choroidal blood vessels, whereas the visualization of the branching network in OCTA may be impaired due to the projection artefact, which generates a mirror effect secondary to the existence of hyperreflective structures such as RPE.17,18 However, studies involving a larger number of patients are needed to verify the capability of MSI in detecting and specifying the BVNs.

MSI longer wavelengths (specifically 620 nm to 740 nm) have an advantage in detecting early RPE defect, as they can enhance visualization of deeper retina and melanin in RPE by removing the effects of short wavelength scatter.19 In this study, we demonstrated with MSI longer wavelengths that RPE atrophy with melanin stacking existed in most of the cases (81.3%). Histopathology studies have proved polypoidal lesions or BVN can create mechanical stress and pressure in the RPE layers, causing cellular damage and disruptions in the continuity of the RPE.20 Nevertheless, RPE defect is also commonly observed in other fundus diseases, such as AMD, CSCR, Stargardt disease, etc., or seen as a proof of previous retinal injuries. The detection of RPE atrophy by MSI could be nonspecific in patients with PCV, especially when coexisting with CSCR or atrophic AMD. However, MSI may help clinicians to sensitively monitor the metabolic and functional changes of the RPE, which is important for pretreatment evaluation and follow-up.

Limitations of this study include the restricted number of patients; therefore, the results of this study need to be validated with further reports involving a larger number of cases. Furthermore, only typical PCV cases were recruited in this study. Finally, as the current MSI device only provides a field of view of about 40°, peripheral polypoidal lesions that were only seen in ICGA had to be neglected when we analyzed MSI images in parallel. This may lead to statistical errors for future studies involving the calculation of polyps. In addition, MSI could not reveal the breakdown of blood-retinal barrier, which is important to decide the activity of PCV.

In conclusion, MSI is a novel imaging modality, and we demonstrated in this study that it allowed the noninvasive visualization of morphological and pathological changes in PCV. Although ICGA has been the gold-standard diagnostic tool for PCV, intravenous dye has potentially life-threatening (anaphylactic shock) risks. Noninvasive imaging techniques such as MSI give a good option to clinicians, especially when ICGA is not practical at each visit owning to time-consuming issues.

References

  1. Yannuzzi LA, Sorenson J, Spaide RF, Lipson B. Idiopathic polypoidal choroidal vasculopathy (IPCV). Retina. 1990;10(1):1–8. doi:10.1097/00006982-199010010-00001 [CrossRef]
  2. Wang M, Zhou Y, Gao SS, et al. Evaluating polypoidal choroidal vasculopathy with optical coherence tomography angiography. Invest Ophthalmol Vis Sci. 2016;57(9):OCT526–532. doi:10.1167/iovs.15-18955 [CrossRef]
  3. Ciardella AP, Donsoff IM, Huang SJ, Costa DL, Yannuzzi LA. Polypoidal choroidal vasculopathy. Surv Ophthalmol. 2004;49(1):25–37. doi:10.1016/j.survophthal.2003.10.007 [CrossRef]
  4. Spaide RF, Yannuzzi LA, Slakter JS, Sorenson J, Orlach DA. Indocyanine green videoangiography of idiopathic polypoidal choroidal vasculopathy. Retina. 1995;15(2):100–110. doi:10.1097/00006982-199515020-00003 [CrossRef]
  5. Sato T, Kishi S, Watanabe G, Matsumoto H, Mukai R. Tomographic features of branching vascular networks in polypoidal choroidal vasculopathy. Retina. 2007;27(5):589–594. doi:10.1097/01.iae.0000249386.63482.05 [CrossRef]
  6. Zhang J, Yu Z, Liu L. Multimodality imaging in diagnosing polypoidal choroidal vasculopathy. Optom Vis Sci. 2015;92(1):e21–26. doi:10.1097/OPX.0000000000000440 [CrossRef]
  7. Wang Y, Chen ZQ, Wang W, Fang XY. Multimodal imaging evaluations of focal choroidal excavations in eyes with central serous chorioretinopathy. J Ophthalmol. 2016;2016:7073083. doi:10.1155/2016/7073083 [CrossRef]
  8. Bhavsar KV, Mukkamala LK, Freund KB. Multimodal imaging in a severe case of hydroxychloroquine toxicity. Ophthalmic Surg Lasers Imaging Retina. 2015;46(3):377–379. doi:10.3928/23258160-20150323-14 [CrossRef]
  9. Zhu X, Cheng Y, Pan X, et al. Sensitivity and specificity of multispectral imaging in detecting central serous chorioretinopathy. Lasers Surg Med. 2017;49(5):498–505. doi:10.1002/lsm.22619 [CrossRef]
  10. Everdell NL, Styles IB, Calcagni A, Gibson J, Hebden J, Claridge E. Multispectral imaging of the ocular fundus using light emitting diode illumination. Rev Sci Instrum. 2010;81(9):093706. doi:10.1063/1.3478001 [CrossRef]
  11. Zimmer C, Kahn D, Clayton R, et al. Innovation in diagnostic retinal imaging: Multispectral imaging. Retina Today. 2014;9:94–99.
  12. Calcagni A, Gibson JM, Styles IB, Claridge E, Orihuela-Espina F. Multispectral retinal image analysis: a novel non-invasive tool for retinal imaging. Eye (Lond). 2011;25(12):1562–1569. doi:10.1038/eye.2011.202 [CrossRef]
  13. Xu Y, Liu X, Cheng L, Su L, Xu X. A light-emitting diode (LED)-based multispectral imaging system in evaluating retinal vein occlusion. Lasers Surg Med. 2015;47(7):549–558. doi:10.1002/lsm.22392 [CrossRef]
  14. Ross RD, Gitter KA, Cohen G, Schomaker KS. Idiopathic polypoidal choroidal vasculopathy associated with retinal arterial macroaneurysm and hypertensive retinopathy. Retina. 1996;16(2):105–111. doi:10.1097/00006982-199616020-00003 [CrossRef]
  15. Watanabe G, Fujii H, Kishi S. Imaging of choroidal hemodynamics in eyes with polypoidal choroidal vasculopathy using laser speckle phenomenon. Jpn J Ophthalmol. 2008;52(3):175–181. doi:10.1007/s10384-007-0521-7 [CrossRef]
  16. Tan CS, Ngo WK, Chen JP, Tan NW, Lim THEVEREST Study Group. EVEREST study report 2: Imaging and grading protocol, and baseline characteristics of a randomised controlled trial of polypoidal choroidal vasculopathy. Br J Ophthalmol. 2015;99(5):624–628. doi:10.1136/bjophthalmol-2014-305674 [CrossRef]
  17. Spaide RF, Fujimoto JG, Waheed NK. Image artifacts in optical coherence tomography angiography. Retina. 2015;35(11):2163–2180. doi:10.1097/IAE.0000000000000765 [CrossRef]
  18. Srour M, Querques G, Semoun O, et al. Optical coherence tomography angiography characteristics of polypoidal choroidal vasculopathy. Br J Ophthalmol. 2016;100(11):1489–1493. doi:10.1136/bjophthalmol-2015-307892 [CrossRef]
  19. Dugel PU, Zimmer CN. Imaging of melanin disruption in age related macular degeneration using multispectral imaging. Ophthalmic Surg Lasers Imaging Retina. 2016;47(2):134–141. doi:10.3928/23258160-20160126-06 [CrossRef]
  20. Yamagishi T, Koizumi H, Yamazaki T, Kinoshita S. Changes in fundus autofluorescence after treatments for polypoidal choroidal vasculopathy. Br J Ophthalmol. 2014;98(6):780–784. doi:10.1136/bjophthalmol-2013-303739 [CrossRef]

Clinical Characteristics of Patients With PCV and Their ICGA and MSI Findings

ICGA MSI
No. Sex Age, Y Eye LogMAR Presence of BVN Relationship in Location Between Polypoidal Lesions and PED Location of Polyps Pattern of Polypoidal Lesions Presence of BVN PED RPE Atrophy and Melanin Stacking
1 M 42 OD 0.398 + No PED Subfoveal Nodular + +
2 F 62 OS 0.398 + Margin of PED Subfoveal Nodular + +
3 M 65 OS 1.000 + Inside PED Juxtafoveal Nodular + +
4 M 62 OS 0.398 + Margin of PED Juxtafoveal Nodular + + +
5 M 61 OD 0.222 + Margin of PED Peripapillary Nodular + + +
6 M 72 OD 1.000 + Inside PED Subfoveal Nodular + +
7 M 72 OS 1.699 + Inside PED Juxtafoveal Nodular + +
8 M 52 OS 0.523 + Inside PED Subfoveal Nodular + + +
9 M 71 OS 0.523 + Inside PED Juxtafoveal Nebulous + + +
10 M 52 OD 0.301 + No PED Subfoveal Nodular + + +
11 M 66 OS 1.000 + Inside PED Beyond temporal vein Nebulous + + +
12 F 57 OS 0.398 + Margin of PED Subfoveal Nodular + + +
13 F 77 OS 0.222 Inside PED Subfoveal Not detected +
14 M 56 OD 1.000 + Inside PED Juxtafoveal Nodular + + +
15 M 56 OS 0.000 + Inside PED Juxtafoveal Nodular + + +
16 M 58 OD 1.000 + Margin of PED Juxtafoveal Nodular + +
Authors

From the Department of Ophthalmology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.

The authors report no relevant financial disclosures.

Address correspondence to Lin Liu, MD, Department of Ophthalmology, Renji Hospital, 160 Pujian Road, Shanghai 200127, China; email: eyerenji@126.com.

Received: September 21, 2017
Accepted: April 25, 2018

10.3928/23258160-20181203-15

Sign up to receive

Journal E-contents