Vessel tortuosity increased as the stage of NPDR was more severe, but decreased in PDR. The vessel tortuosity determined using optical coherence tomography angiography might be a useful parameter indicating the progression to PDR, circumventing the risk from invasive conventional angiography.

Objectives To compare and evaluate the characteristics of hypertensive choroidopathy with serous retinal detachment in preeclampsia and malignant hypertension (HTN) and explore choroidal ischemia as a pathogenesis using multimodal imaging. Methods A retrospective multicenter case series. Medical charts were reviewed. Clinical characteristics and multimodal imaging, including optical coherence tomography (OCT) and OCT angiography (OCTA), were evaluated. Results Fifty-three eyes of 29 preeclampsia patients and 45 eyes of 24 HTN patients were included. There were no differences in age, follow-up duration, baseline visual acuity, central macular thickness (CMT), or subfoveal choroidal thickness (CT) between the two groups. Blood pressure parameters, including systolic blood pressure, diastolic blood pressure, and pulse rate, were significantly higher in the HTN group. After serous retinal detachment resolved, both CMT (p < 0.001) and CT (p = 0.003) decreased more in the preeclampsia group. Hypertensive retinopathy features, including hemorrhage, exudates, cotton-wool spots, and optic disc edema, were predominantly found in the HTN group (p = 0.001). Final visual acuity was better in the preeclampsia group than in the HTN group (p = 0.048). Poor visual prognostic factors included the presence of retinopathy features (p = 0.005) and retinal detachment in the macula (p = 0.017). Conclusion Choroidal circulation may be affected earlier than retinal circulation by elevated blood pressure, presumably because of anatomical differences and autoregulatory mechanisms in the retinal vasculature. Serous retinal detachment with hypertensive choroidopathy presented with choroidal thickening that decreased after resolution, but the residual flow defects observed in the choriocapillaris on OCTA confirmed the long-hypothesized notion that ischemia is a mechanism underlying hypertensive choroidopathy.

Citation: Lee M, Lee H, Kim HC, Chung H. Changes in stromal and luminal areas of the choroid in pachychoroid diseases: insights into the pathophysiology of pachychoroid diseases. Invest Ophthalmol Vis Sci. 2018;59:4896-4908. https://doi.org/ 10.1167/iovs.18-25018 PURPOSE.To evaluate and compare changes in choroidal vascular and stromal areas in patients with three major pachychoroid diseases for better insight into the pathophysiology of these diseases.METHODS. Eighty-six eyes of 86 patients (50 men and 36 women; mean age, 49.1 years) were evaluated, including 21 patients with chronic central serous chorioretinopathy (CSC), 14 with pachychoroid pigment epitheliopathy (PPE), 19 with pachychoroid neovasculopathy (PNV), 14 with myopic choroidal neovascularization (mCNV), and 18 controls. Multimodal retinal imaging, including enhanced-depth imaging optical coherence tomography (EDI-OCT), was performed. Each EDI-OCT image was binarized with ImageJ software, and luminal (dark pixels) and stromal (light pixels) areas were calculated (3000 lm wide in the subfoveal choroid centered on the fovea). RESULTS.The subfoveal choroidal thickness (SFCT) was greater in the three pachychoroid groups than in the control group (430.01 vs. 282.61 lm, P < 0.001). There was no significant difference in SFCT among the three pachychoroid groups. The luminal-to-total choroidal ratio (L/C) was highest (ANOVA, P ¼ 0.001) and the stromal-to-total choroidal ratio (S/C) lowest in the CSC group (ANOVA, P ¼ 0.001). Interestingly, stromal area changes were not correlated with SFCT in the CSC and PNV groups, in contrast to the good correlation between luminal area changes and SFCT in these groups.CONCLUSIONS. The eyes of CSC patients had significantly smaller choroidal stromal areas than those of controls or of PPE, PNV, or mCNV patients. The differences in choroidal stromal area, L/C, and S/C in different pachychoroid diseases may reflect different predominant pathogenic processes.

Purpose: To evaluate the association between treatment response and quantitative morphological changes in choroidal neovascularization and outer choroidal vessels using optical coherence tomography angiography (OCTA) and en face OCT in neovascular age-related macular degeneration (nAMD). Methods: We retrospectively analyzed 75 eyes of typical nAMD patients and 53 polypoidal choroidal vasculopathy eyes of 124 patients with OCTA performed at least 6 months after initial antivascular endothelial growth factor treatment. Quantitative parameters, including vessel area, vessel diameter, branch vessel length, fractal dimension, and lacunarity were analyzed based on en face images of the choroidal neovascularization and choroidal vessel in Haller's layer. Parameters associated with loss of logarithm of the minimum angle of resolution visual acuity with the basis of 0.3 and the treatment interval (good vs. poor responder based on 12 weeks) were analyzed. Analyses were conducted for “before OCTA” (initial visit to OCTA) and “after OCTA” (OCTA to 6 months post-OCTA). Results: In typical nAMD, visual acuity loss before OCTA was associated with a higher SD of choroidal neovascularization diameter and lower choroidal fractal dimension. Visual acuity loss after OCTA in typical nAMD was associated with higher lacunarity of the choroid. Poor responders before OCTA were not associated with any factor. Poor responders after OCTA were associated with a lower SD of outer choroidal vessel diameter in typical nAMD. In polypoidal choroidal vasculopathy, no factor was associated with clinical outcomes in either period. Conclusion: Quantitative analyses of choroidal neovascularization on OCTA and choroidal vessels on en face OCT provide information about treatment response, including changes in visual acuity and treatment interval, in nAMD.

No abstract