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IMPROVED DETECTION AND DIAGNOSIS OF POLYPOIDAL CHOROIDAL VASCULOPATHY USING A COMBINATION OF OPTICAL COHERENCE TOMOGRAPHY AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.
Retina. 2019 Sep; 39(9):1655-1663.R

Abstract

PURPOSE

To assess the ability of optical coherence tomography (OCT) alone and in combination with OCT angiography (OCTA) to differentiate polypoidal choroidal vasculopathy (PCV) from neovascular age-related macular degeneration, as compared to fluorescein angiography and indocyanine green angiography.

METHODS

This is a cross-sectional study. All participants had a standardized history, clinical examination including measurement of best-corrected visual acuity, slit-lamp biomicroscopy, and indirect fundus examination, and underwent standardized imaging (color photography, fluorescein and indocyanine green angiography, OCT, and OCTA) after predefined protocols. We used a 2-step approach (Step 1: spectral domain OCT; Step 2: addition of OCTA) combining structural OCT and OCTA to differentiate 50 treatment-naive eyes with PCV, choroidal neovascularization, and retinal angiomatous proliferation and compared with the diagnosis based on fluorescein angiography and indocyanine green angiography. Spectral domain OCT signs used to diagnose PCV included presence of two out of three of any retinal pigment epithelium detachment (pigment epithelial detachment/double-layer sign), notched or narrow-peaked pigment epithelial detachment, or round subretinal pigment epithelium structure. Optical coherence tomography angiography signs used to diagnose PCV included presence of a localized subretinal pigment epithelium hyperflow signal in the cross-sectional OCTA and/or presence of a focal hyperflow sign in en face OCTA based on outer retina slab.

RESULTS

Based on fluorescein angiography and indocyanine green angiography, the diagnosis was choroidal neovascularization in 24 eyes, PCV in 23 eyes, and retinal angiomatous proliferation in 3 eyes. Based on spectral domain OCT signs, PCV was diagnosed in 19/23 (82.6%) eyes; however, specificity of OCT was only 51.9%. Cross-sectional OCTA showed a diffuse hyperflow signal in all 24 (100.0%) eyes with choroidal neovascularization, whereas a localized subretinal pigment epithelium hyperflow signal was detected in 19/23 (82.6%) eyes with PCV. En face OCTA only detected a nodular hyperflow signal in 10/23 eyes (43.5%) with PCV. Combination of OCT and OCTA achieved 82.6% sensitivity and 100.0% specificity for differentiating PCV from choroidal neovascularization/retinal angiomatous proliferation.

CONCLUSION

Cross-sectional OCTA is more sensitive than en face OCTA in detecting flow signal in polyps. Combination of structural OCT and OCTA can be used to screen for PCV with a high level of sensitivity and specificity.

Authors+Show Affiliations

Medical Retina Service, Singapore National Eye Center, Singapore, Singapore.Medical Retina Service, Singapore National Eye Center, Singapore, Singapore.Topcon Corporation, Japan.Medical Retina Service, Singapore National Eye Center, Singapore, Singapore.Medical Retina Service, Singapore National Eye Center, Singapore, Singapore.Medical Retina Service, Singapore National Eye Center, Singapore, Singapore.Medical Retina Service, Singapore National Eye Center, Singapore, Singapore.Medical Retina Service, Singapore National Eye Center, Singapore, Singapore.

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article

Language

eng

PubMed ID

29927796

Citation

Cheung, Chui Ming Gemmy, et al. "IMPROVED DETECTION and DIAGNOSIS of POLYPOIDAL CHOROIDAL VASCULOPATHY USING a COMBINATION of OPTICAL COHERENCE TOMOGRAPHY and OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY." Retina (Philadelphia, Pa.), vol. 39, no. 9, 2019, pp. 1655-1663.
Cheung CMG, Yanagi Y, Akiba M, et al. IMPROVED DETECTION AND DIAGNOSIS OF POLYPOIDAL CHOROIDAL VASCULOPATHY USING A COMBINATION OF OPTICAL COHERENCE TOMOGRAPHY AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina. 2019;39(9):1655-1663.
Cheung, C. M. G., Yanagi, Y., Akiba, M., Tan, A., Mathur, R., Chan, C. M., Yeo, I., & Wong, T. Y. (2019). IMPROVED DETECTION AND DIAGNOSIS OF POLYPOIDAL CHOROIDAL VASCULOPATHY USING A COMBINATION OF OPTICAL COHERENCE TOMOGRAPHY AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina (Philadelphia, Pa.), 39(9), 1655-1663. https://doi.org/10.1097/IAE.0000000000002228
Cheung CMG, et al. IMPROVED DETECTION and DIAGNOSIS of POLYPOIDAL CHOROIDAL VASCULOPATHY USING a COMBINATION of OPTICAL COHERENCE TOMOGRAPHY and OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina. 2019;39(9):1655-1663. PubMed PMID: 29927796.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - IMPROVED DETECTION AND DIAGNOSIS OF POLYPOIDAL CHOROIDAL VASCULOPATHY USING A COMBINATION OF OPTICAL COHERENCE TOMOGRAPHY AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. AU - Cheung,Chui Ming Gemmy, AU - Yanagi,Yasuo, AU - Akiba,Masahiro, AU - Tan,Anna, AU - Mathur,Ranjana, AU - Chan,Choi Mun, AU - Yeo,Ian, AU - Wong,Tien Y, PY - 2018/6/22/pubmed PY - 2020/7/28/medline PY - 2018/6/22/entrez SP - 1655 EP - 1663 JF - Retina (Philadelphia, Pa.) JO - Retina VL - 39 IS - 9 N2 - PURPOSE: To assess the ability of optical coherence tomography (OCT) alone and in combination with OCT angiography (OCTA) to differentiate polypoidal choroidal vasculopathy (PCV) from neovascular age-related macular degeneration, as compared to fluorescein angiography and indocyanine green angiography. METHODS: This is a cross-sectional study. All participants had a standardized history, clinical examination including measurement of best-corrected visual acuity, slit-lamp biomicroscopy, and indirect fundus examination, and underwent standardized imaging (color photography, fluorescein and indocyanine green angiography, OCT, and OCTA) after predefined protocols. We used a 2-step approach (Step 1: spectral domain OCT; Step 2: addition of OCTA) combining structural OCT and OCTA to differentiate 50 treatment-naive eyes with PCV, choroidal neovascularization, and retinal angiomatous proliferation and compared with the diagnosis based on fluorescein angiography and indocyanine green angiography. Spectral domain OCT signs used to diagnose PCV included presence of two out of three of any retinal pigment epithelium detachment (pigment epithelial detachment/double-layer sign), notched or narrow-peaked pigment epithelial detachment, or round subretinal pigment epithelium structure. Optical coherence tomography angiography signs used to diagnose PCV included presence of a localized subretinal pigment epithelium hyperflow signal in the cross-sectional OCTA and/or presence of a focal hyperflow sign in en face OCTA based on outer retina slab. RESULTS: Based on fluorescein angiography and indocyanine green angiography, the diagnosis was choroidal neovascularization in 24 eyes, PCV in 23 eyes, and retinal angiomatous proliferation in 3 eyes. Based on spectral domain OCT signs, PCV was diagnosed in 19/23 (82.6%) eyes; however, specificity of OCT was only 51.9%. Cross-sectional OCTA showed a diffuse hyperflow signal in all 24 (100.0%) eyes with choroidal neovascularization, whereas a localized subretinal pigment epithelium hyperflow signal was detected in 19/23 (82.6%) eyes with PCV. En face OCTA only detected a nodular hyperflow signal in 10/23 eyes (43.5%) with PCV. Combination of OCT and OCTA achieved 82.6% sensitivity and 100.0% specificity for differentiating PCV from choroidal neovascularization/retinal angiomatous proliferation. CONCLUSION: Cross-sectional OCTA is more sensitive than en face OCTA in detecting flow signal in polyps. Combination of structural OCT and OCTA can be used to screen for PCV with a high level of sensitivity and specificity. SN - 1539-2864 UR - https://www.unboundmedicine.com/medline/citation/29927796/IMPROVED_DETECTION_AND_DIAGNOSIS_OF_POLYPOIDAL_CHOROIDAL_VASCULOPATHY_USING_A_COMBINATION_OF_OPTICAL_COHERENCE_TOMOGRAPHY_AND_OPTICAL_COHERENCE_TOMOGRAPHY_ANGIOGRAPHY_ L2 - https://doi.org/10.1097/IAE.0000000000002228 DB - PRIME DP - Unbound Medicine ER -