Choroidal macrovascular and capillary alterations in eyes with idiopathic epiretinal membranes

ABSTRACT Purpose: To evaluate the choroidal vascular alterations and effect of surgical treatment in the setting of idiopathic epiretinal membranes. Methods: The structure of the choroid was studied in 33 patients with unilateral idiopathic epiretinal membrane using optical coherence tomography with enhanced depth imaging and optical coherence tomography angiography. Eyes with epiretinal membrane underwent 25-gauge vitrectomy with epiretinal membrane and internal limiting membrane peeling. The choroidal vascularity index, Haller layer/choroidal thickness ratio, and choriocapillaris flow density were used to evaluate changes in choroidal structure after surgery and compare with the healthy fellow eyes. Results: The choroidal vascularity index and Haller layer/choroidal thickness ratio of the eyes with epiretinal membrane were higher than those of the fellow eyes at baseline (p=0.009 and p=0.04, respectively) and decreased postoperatively compared with preoperative values (p=0.009 and p=0.001, respectively). The choriocapillaris flow of eyes with epiretinal membrane was lower than that of the fellow eyes at baseline (p=0.001) and increased after surgery compared with the preoperative value (p=0.04). The choroidal vascularity index, Haller layer/choroidal thickness ratio, and choriocapillaris flow values of the healthy fellow eyes were comparable at baseline and final visit. In eyes with epiretinal membrane, the final choroidal vascularity index correlated with the final choriocapillaris flow (r=-0.749, p=0.008) in the multivariate analysis. Conclusion: Idiopathic epiretinal membrane appears to affect the choroidal structure with increased choroidal vascularity index and Haller layer/choroidal thickness ratio and decreased choriocapillaris flow. These macrovascular (choroidal vascularity index and Haller layer/choroidal thickness) and microvascular (choriocapillaris flow) alterations appear to be relieved by surgical treatment of the epiretinal membranes.

Idiopathic polypoidal choroidal vasculopathy masquerading as choroidal tumors: one year follow-up of a peripheral lesion / Vasculopatia polipoidal idiopática da coroide simulando tumores da coroide: um ano de seguimento de uma lesão periférica

ABSTRACT This case report describes peripheral idiopathic polypoidal choroidal vasculopathy (IPCV) with a collection of small aneurysmal dilations that masqueraded as choroidal tumors in an elderly patient. A 68-year-old African American woman was referred to us with a suspected diagnosis of asymptomatic vascular choroidal tumor and choroidal capillary hemangioma, affecting the temporal peripheral fundus. Upon examination, optical coherence tomography (OCT) revealed two large hemorrhagic pigment epithelium detachments (PED), and indocyanine green angiography (ICG) confirmed the diagnosis of IPCV. One year later, there was reduction in the hemorrhagic pigment epithelium detachments and the lesion took on a different appearance, resembling a choroidal osteoma. No treatment was necessary despite the presence of multiple polyps. IPCV is a rare condition that can resemble other choroidal diseases depending on the stage of presentation. OCT is the best tool to determine the characteristics of the lesions, and indocyanine green angiography should be used to confirm the diagnosis. Not all cases require treatment.

RESUMO Relato de um caso de vasculopatia polipoidal idiopática da coroide (IPCV) com múltiplas dilatações aneurismáticas em região temporal periférica da retina, em uma paciente idosa que assemelhou-se com alguns tumores de coroide no seguimento de um ano. Paciente de 68 anos da raça negra, assintomática, foi encaminhada com a hipótese diagnóstica de um tumor vascular de coroide e hemangioma capilar da coroide, em região temporal inferior periférica da retina. Ao exame de tomografia de coerência óptica (OCT) era observado dois grande descolamentos de epitélio pigmentado (DEP), sendo confirmado o diagnóstico de vasculopatia polipoidal idiopática da coroide pela angiografia com indocianina verde (ICG). Após um ano, houve absorção do descolamento do epitélio pigmentado hemorrágico assemelhando-se assim ao osteoma de coroide. Nenhum tratamento foi necessário apesar da quantidade dos pólipos. A vasculopatia polipoidal idiopática da coroide é uma doença rara que, dependendo do estágio da apresentação, pode se assemelhar com algumas doenças da coroide. A tomografia de coerência óptica pode ilustrar melhor as características das lesões e a ICG confirma o diagnóstico. Nem todos os casos necessitam ser tratados.

Comparison of peripapillary choroidal watershed zones in different types of glaucoma / 中华眼底病杂志

Objective To observe the location of peripapillary choroidal watershed zones relative to the optic disc in the different types of glaucoma.Methods A total of 98 patients (98 eyes) with glaucoma (glaucoma group) were enrolled in this study.The eyes included 34 eyes with primary open-angle glaucoma (POAG group),33 eyes with normal tension glaucoma (NTG group) and 31 eyes with chronic angle closure glaucoma (CACG group).Thirty-seven fellow eyes of 37 patients with monocular blunt trauma were selected in this study as control group.The differences of age (t=1.197),sex (x2=3.548),average diopter (t=-1.644) between glaucoma group and control group were not statistically significant (P＞0.05).The differences of age (F=2.645),sex (F=1.984),average diopter (F=2.621),and visual fields mean defect (MD) (F=0.899) between different types of glaucoma were also not statistically significant (P＞0.05).Simultaneous indocyanine green angiography (ICGA) and fundus fluorescein angiography (FFA) were performed on all subjects.The watershed zones were classified into three types according to its location relative to the optic disc:in type Ⅰ,the watershed zone did not include the optic disc or could not be observed; in type Ⅱ,the watershed zone partially included the optic disc; in type Ⅲ,the watershed zone completely included the optic disc.The location of watershed zones relative to the optic disc in the different types of glaucoma was comparatively analyzed.The relationship between watershed zones,type and age,and MD were also analyzed by Pearson analysis method.Results The constituent ratio of type Ⅱ and Ⅲ watershed zones were 81.6％ and 56.8％ in glaucoma group and control group,respectively; with a statistically significant difference (x2=8.756,P ＜ 0.003).The constituent ratios of type Ⅱ and Ⅲ watershed zones were 82.4％,90.9％,71.1％ in POAG,NTG and CACG group,respectively.No significant differences were found between POAG and NTG group (x2 =1.039),POAG and CACG group (x2 =1.039,1.166; P＞0.05).But there was significant difference between NTG and CACG group (x2 =4.107,P＜0.05).Significant differences were found between POAG and control group,NTG and control group (x2=5.352,10.141;P＜ 0.05).No significant difference was found between CACG and control group (x2=1.444,P＞0.05).There was no correlation between age and watershed zone type (r=0.114,P＞0.05).The watershed zones type of glaucoma group positively correlated with MD (r=0.354,P=0.000).Conclusion The peripapillary choroidal watershed zones in glaucoma patients include the optic disc more than in healthy eyes.

Indocyanine green angiography in ocular contusion / 中华眼底病杂志

Purpose To observe the changes of choroidal circulation and the retinal lesions caused by ocular contusion with indocyanine green angiography (ICGA). Methods ICGA examination was performed on 30 cases (30 eyes) of various traumatic condition in conjunction with fundus fluorescein angiography (FFA). Results FFA of 19 cases (63.3%) showed the hypofluorence in quadrant or whole disc in accordance with the area of delayed filling of choroid. Twenty six cases (86.2%) showed defected choroidel perfusion in ICGA,among them 16 cases showed localized delayed perfusion, in which the shortest perfusion time was 1 min 50 s and the longest time was 5 min.43 s,and 10 patients showed localized perfusion defect,and reversed filling time of retinochoroid vessels in 6 patients. Five cases (16.6%) had delayed filling time in both choroidal and central retinal vessels. Damage of retinal pigment epithelium was found in the areas of choroidal abnormal perfusion. Conclusion ICGA combined with simultaneously FFA, is valuable in evaluating blunt injury of the ocular fundus and beneficial to its diagnosis and treatment.

Choriocapillaris circulatory study of macula in aging macular degeneration / 中华眼底病杂志

Purpose To discuss changes of macular choriocapillaris hemodynamics in AMD. Methods Eighty six eyes of 86 patients underwent ICGA,including macular drusen in 15 eyes of 15 patients,exudative AMD in 52 eyes of 52 patients,atrophic AMD in 19 eyes of 19 patients,for the observation of macular choriocapillaris perfusion. Results Choriocapillaris filling phase (CFP) of exudative AMD was obviously longer than that of eyes with normal, atrophic AMD and drusen groups ( P