Vortex Vein Imaging: What Can It Tell Us?

Verma, Aditya; Bacci, Tommaso; Sarraf, David; Freund, K. Bailey; Sadda, Srinivas R

doi:10.2147/opth.s324245

Cited by 12 publications

(8 citation statements)

References 82 publications

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“…Previous study proposed that the anastomoses in CSC occurred nearly uniformly among the superonasal, superotemporal, and inferotemporal vortex vein systems 10 , 13 , 14 . The relatively asymmetric distribution of choroidal thickness, choroidal volumes and large-choroidal vessel density found in our study may further support the view that the pathogenesis of typical CSC could involve congestion due to the impaired drainage of the affected vortex veins 1 , 8 , 10 , 14 – 16 , consistent with the result of Ishikura et al’s study 12 . In the study by Nishihara et al 17 , they found the choroidal thickness was significantly thicker in the eyes with CSC than that in the normal eyes at subfoveal choroidal thickness, at 5 mm superior, and at 7 mm superior from the fovea.…”

Section: Discussionsupporting

confidence: 92%

Quantitative analysis of choroidal vasculature in central serous chorioretinopathy using ultra-widefield swept-source optical coherence tomography angiography

Zeng

Yao

et al. 2022

Sci Rep

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We aimed to quantitatively compare the choroid blood flow and choroid thickness at the periphery among eyes with central serous chorioretinopathy (CSC), fellow eyes and healthy eyes using ultra-widefield swept-source optical coherence tomography angiography (UWF SS-OCTA). Retrospective analysis of 49 patients with CSC (98 eyes, including unaffected fellow eyes) and 49 age and sex matched controls were included. We obtained 3-dimensional data of vertical 20 mm × horizontal 24 mm × scan depth 6 mm, comprising 9 subfields (superotemporal, upper, superonasal, temporal, central, nasal, inferotemporal, lower, inferonasal regions). CSC eyes presented with greater density of large-vessel choroidal layer in all the 9 subfields compared with controls. Compared with normal eyes, CSC eyes had greater choroidal thickness (superotemporal, upper, superonasal, temporal, central, nasal, inferotemporal, and inferonasal subfields) and choroidal volume (superotemporal, upper, superonasal, temporal, central, and nasal subfields). Compared with control eyes, the choriocapillaris density in the superotemporal, inferotemporal and inferonasal subfields was greater in patients with CSC. Our study may provide further evidence for the congestion of vortex vein in the pathogenesis of CSC. UWF SS-OCTA can be used to evaluate the abnormalities of the choroidal structures even at the periphery in eyes with CSC.

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Section: Discussionsupporting

confidence: 92%

Quantitative analysis of choroidal vasculature in central serous chorioretinopathy using ultra-widefield swept-source optical coherence tomography angiography

Zeng

Yao

et al. 2022

Sci Rep

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“…Ischemia secondary to occlusion of the choriocapillaris triggers the development of CNV. Our theory of anastomosis is becoming a new trend in the understanding of pachychoroid diseases [ 34 – 37 ].…”

Section: Discussionmentioning

confidence: 99%

A new insight into pachychoroid diseases: Remodeling of choroidal vasculature

Kishi

Matsumoto

2022

Graefes Arch Clin Exp Ophthalmol

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Purpose Pachychoroid spectrum diseases are regarded as being different manifestations of a common pathogenic process. We suggest that pachychoroid diseases are consequences of chronic vortex vein stasis. Methods We describe how we came to this conclusion based on our own recent reports as well as a search of the related literature. Results Central serous chorioretinopathy (CSC) is the first stage of pachychoroid spectrum diseases. CSC is caused by congestion of choroidal veins, which are branches of the vortex veins. The venous outflow tract of the choroid is divided into four quadrants, based on horizontal and vertical watershed zones, with one or two vortex veins in each quadrant being independently responsible for venous outflow. In acute CSC, vortex vein stasis frequently causes asymmetric dilatation of the vortex veins in the horizontal watershed. The area of geographic filling delay in the choriocapillaris coincides with the area of this asymmetrically dilated vortex veins. With chronic stasis of the vortex veins, venous anastomosis occurs in the watershed zone as a means of compensating for the stasis, and the choriocapillaris becomes occluded in the area of filling delay. The anastomotic vessels dilate, becoming often hyperpermeable, and are then recognizable as pachyvessels. With the development of choriocapillaris ischemia, choroidal neovascularization (CNV) occurs at the site of pachyvessels. This is termed pachychoroid neovasculopathy (PNV). Polypoidal choroidal vasculopathy is regarded as a variant of PNV. Conclusions Intervortex venous anastomosis is among the key factors underlying the development of pachychoroid diseases. Remodeling of the venous drainage route though the anastomosis across the watershed zones is apparently a common response to chronic vortex vein stasis.

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“…The vortex vessels, located in the middle layer of the eyeball wall, drain the choroid. They are difficult to detect by direct observation but can be observed more clearly with indocyanine green angiography (ICGA) than with other non-invasive techniques (6). However, research on vortex veins mostly transforms the ICGA image into binary image, and then manually segment the quadrants based on the position of the vortex vein to measure the brightness of each quadrant for research (7).…”

Section: Introductionmentioning

confidence: 99%

Vortex vein engorgement and different shapes of venous drainage systems in polypoid choroidal vasculopathy vs. age‑related macular degeneration on indocyanine green angiography

Cai

Xiong

et al. 2023

Exp Ther Med

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There are differences in vortex vein engorgement and appearance in polypoid choroidal vasculopathy (PCV), age-related macular degeneration (AMD), and healthy eyes. The present study aimed to use indocyanine green angiography (ICGA) to find a simple, clinically meaningful method for evaluating the filling degree of vortex veins in various eye diseases. Participant clinical characteristics were recorded. The number of vortex veins (NVV), central vortex vein diameter (CVVD), mean root area of the vortex vein (MRAVV), mean diameter of the thickest peripheral branch (MDPTB), subfoveal choroidal thickness and percentage of vortex vein anastomosis (PVVA) were obtained by marking the vortex veins on ICGA. The proportion of subretinal haemorrhage and the numbers and types of vortex veins in each quadrant were counted separately. The CVVD and MDPTB were significantly increased in the PCV compared with those in the AMD group (P<0.05). The CVVD, MRAV, and PVVA were significantly increased in the PCV compared with those in the healthy group (P<0.05). The type IV vortex vein (complete with ampulla) proportion was the lowest while the type I (vortex vein absent) proportion was the highest in the PCV group (P<0.001). NVV in the inferior-temporal region was increased in the PCV compared with that in the AMD group (P=0.034). Subretinal haemorrhage occurred in the inferior temporal choroid in 47.62% of examined eyes in PCV group, and in the superior temporal choroid in 23.81% of the PCV group, with significant differences between the quadrants (P<0.001). Vortex vein engorgement and shape differed significantly between PCV, AMD and healthy eyes. The vortex vein branches in PCV eyes were significantly dilated in the posterior pole; moreover, the peripheral choroid and the lower proportion of type IV vortex veins may be pathognomonic for PCV.

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Vortex Vein Imaging: What Can It Tell Us?

Cited by 12 publications

References 82 publications

Quantitative analysis of choroidal vasculature in central serous chorioretinopathy using ultra-widefield swept-source optical coherence tomography angiography

Quantitative analysis of choroidal vasculature in central serous chorioretinopathy using ultra-widefield swept-source optical coherence tomography angiography

A new insight into pachychoroid diseases: Remodeling of choroidal vasculature

Vortex vein engorgement and different shapes of venous drainage systems in polypoid choroidal vasculopathy vs. age‑related macular degeneration on indocyanine green angiography

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