Optical coherence tomography-based misdiagnosis and morphological distinction in pachychoroid neovasculopathy vs. polypoidal choroidal vasculopathy

Abstract

Purpose To evaluate the rate of misdiagnosis of aneurysmatic pachychoroid type 1 choroidal neovascularization/polypoidal choroidal vasculopathy (PAT1/PCV) among cases diagnosed as non-aneurysmatic pachychoroid neovasculopathy (PNV) and to define optical coherence tomography (OCT) features facilitating their distinction. Methods The database of the Department of Ophthalmology, Ludwig-Maximilians University Munich, was screened for patients diagnosed with PNV. Multimodal imaging was screened for the presence of choroidal neovascularization (CNV) and aneurysms/polyps. Imaging features facilitating the diagnosis of PAT1/PCV were analysed. Results In total, 49 eyes of 44 patients with a clinical PNV diagnosis were included, of which 42 (85.7%) had PNV and 7 (14.3%) represented misdiagnosed PAT1/PCV. SFCT was comparable (PNV: 377 ± 92 vs. PAT1/PCV: 400 ± 83 µm; p = 0.39). Whereas no difference was detected in total pigment epithelium detachment (PED) diameter (p = 0.46), maximum PED height was significantly higher in the PAT1/PCV group (199 ± 31 vs. 82 ± 46, p < 0.00001). In a receiver operating characteristic (ROC) analysis, the optimum cutoff for defining “peaking PED” was 158 µm with an area under the curve of 0.969, a sensitivity of 1.0 (95% CI: 0.59–1.0), and a specificity of 0.95 (95% CI: 0.84–0.99). Sub-retinal hyperreflective material (SHRM; p = 0.04), sub-retinal ring-like structures (SRRLS; p < 0.00001), and sub-RPE fluid (p = 0.04) were significantly more frequent in eyes with PAT1/PCV. Conclusion A relevant percentage of eyes diagnosed with PNV might instead suffer from PAT1/PCV. The detection of a maximum PED height (“peaking PED”) exceeding approximately 150 µm, SHRM, SRRLS, and sub-RPE fluid might greatly aid in the production of a more accurate diagnosis.

Intraocular lens power calculation for silicone oil-dependent eyes

“…Specifically, four patients were diagnosed with polypoidal choroidal vasculopathy (PCV), which characteristically presents as a sub-retinal pigment epithelium (RPE) lesion ( 15 ). RPE destruction was also observed in patients with PCV, leading to suboptimal attachment of the neurosensory epithelium and RPE ( 16 ). To prevent any further complications and instability of the neuroepithelium, massive old sub-neurosensory-retinal hemorrhage in these four patients prompted the retention of the SO.…”

Advances in multi-modal non-invasive imaging techniques in the diagnosis and treatment of polypoidal choroidal vasculopathy

“…First, the pathogenesis of PCV is not yet clear, and the disease classification is complex (44). Some scholars believe that the high fluorescence signal observed on ICGA may be a common manifestation of many diseases, so the use of other noninvasive imaging for the identification and diagnosis of PCV may lead to misdiagnosis (45). Second, the current diagnostic criteria for a combined diagnosis are mostly for newly diagnosed PCV.…”