Polypoidal choroidal vasculopathy (PCV) is a common choroidal vascular disease particularly in Asians. However, the underlying pathogenesis of PCV is still yet to be fully elucidated, and the correlation between choroidal vasculature and treatment response of PCV are poorly understood. Accordingly, we sought to find clues to understand the pathogenesis and prognosis of PCV by quantitatively evaluating choroidal vasculature from the entire fundus using ultra-widefield (UWF) indocyanine green angiography (ICGA). In this study, 32 eyes from 29 patients with treatment naïve PCV and 30 eyes from 30 healthy control participants were enrolled. Choroidal vascular density (CVD) of PCV eyes was higher than normal eyes in majority regions including the periphery. CVD was positively correlated with choroidal thickness and choroidal hyperpermeability, supporting that the pathogenesis of PCV may include choroidal congestion and dilatation. Thicker choroid and higher CVD were also correlated with poor treatment response after anti-VEGF injections. The CVD, quantified from UWF ICGA can also be used as an effective image biomarker to predict the treatment response in PCV.

The significance of subretinal fluid in the retinal blood flow is unclear. Here, we evaluated the association between subretinal fluid (SRF) and retinal blood flow in eyes with central serous chorioretinopathy (CSC) using a retinal functional imager (RFI) and optical coherence tomography angiography (OCTA). In this retrospective case–control study involving 26 eyes from 18 CSC patients and 25 eyes from 21 age- and sex-matched controls, we found that the CSC group showed significant differences from the control group in terms of the retinal venule blood flow velocity (3.60 ± 0.43 vs 3.96 ± 0.56 mm/s; p = 0.030), retinal venule blood flow rate (8.75 ± 2.67 vs 12.51 ± 7.12 nl/s; p = 0.040), and the diameter of retinal venules (118.26 ± 14.25 vs 126.92 ± 35.31 μm; p = 0.045). Linear regression analysis showed that SRF thickness accounted for a 36.9% reduction in venous BFR (p = 0.013). The difference in the O2 saturation between retinal arteries and veins was greater in the CSC group. There was no correlation between SRF thickness and capillary densities in OCTA. Our findings suggest that disturbance in venous return and the associated altered oxygen may be significant changes in the retinal blood flow dynamics in eyes with SRF.

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