Yanagi Yasuo, Mohla Aditi, Lee Won-Ki, Lee Shu Yen, Mathur Ranjana, Chan Choi Mun, Yeo Ian, Wong Tien Yin, Cheung Chui Ming Gemmy
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 2Ophthalmology and Visual Sciences Program, Duke-NUS Medical School, National University of Singapore, Singapore.
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
Invest Ophthalmol Vis Sci. 2017 Jul 1;58(9):3488-3495. doi: 10.1167/iovs.16-21167.
To determine the prevalence of subclinical nonexudative neovascularization and associated choroidal vascular changes in the fellow eyes of patients presenting with unilateral typical exudative AMD (tAMD) or polypoidal choroidal vasculopathy (PCV) using indocyanine green angiography (ICGA) and swept-source (SS) optical coherence tomography angiography (OCT-A).
We recruited patients presenting with tAMD or PCV in a prospective clinical study. The diagnosis in the presenting eye was determined based on clinical, fluorescein angiography (FA), and ICGA findings. We evaluated the contralateral eye for presence of nonexudative neovascularization, choroidal hyperpermeability, and pachyvessels in the outer choroid, based on multimodal imaging which included ICGA, spectral-domain (SD) OCT and OCT-A. We measured subfoveal choroidal thickness in both eyes for each patient.
We included 76 fellow eyes of 76 patients who presented with unilateral tAMD (n = 33) or PCV (n = 43). Nonexudative neovascularization was present in 18% eyes (14 eyes, 8 in tAMD group, 6 in PCV group; 7 on ICGA, 4 on OCT-A, 3 on both ICGA and OCT-A). Pachychoroid pigment epitheliopathy was present in 13 eyes with nonexudative neovascularization, and was the only risk factor associated with nonexudative neovascularization.
Approximately one in five fellow eyes with unilateral tAMD and PCV have features of nonexudative neovascularization. The use of multimodal imaging including ICGA and OCT-A can identify these features. The presence of pachychoroid epitheliopathy should alert clinicians to the possibility of underlying neovascularization.
使用吲哚菁绿血管造影（ICGA）和扫频源（SS）光学相干断层扫描血管造影（OCT-A），确定单侧典型渗出性年龄相关性黄斑变性（tAMD）或息肉状脉络膜血管病变（PCV）患者对侧眼中亚临床非渗出性新生血管形成及相关脉络膜血管变化的患病率。
我们在一项前瞻性临床研究中招募了患有tAMD或PCV的患者。患眼的诊断基于临床、荧光素血管造影（FA）和ICGA检查结果。我们基于包括ICGA、谱域（SD）OCT和OCT-A在内的多模态成像，评估对侧眼是否存在非渗出性新生血管形成、脉络膜高通透性以及脉络膜外层的厚壁血管。我们测量了每位患者双眼的黄斑中心凹下脉络膜厚度。
我们纳入了76例患有单侧tAMD（n = 33）或PCV（n = 43）患者的76只对侧眼。18%的眼（14只眼，tAMD组8只，PCV组6只；ICGA发现7只，OCT-A发现4只，ICGA和OCT-A均发现3只）存在非渗出性新生血管形成。13只存在非渗出性新生血管形成的眼中有厚脉络膜色素上皮病变，且是与非渗出性新生血管形成相关的唯一危险因素。
单侧tAMD和PCV患者的对侧眼中，约五分之一具有非渗出性新生血管形成的特征。使用包括ICGA和OCT-A在内的多模态成像可以识别这些特征。厚脉络膜上皮病变的存在应提醒临床医生注意潜在新生血管形成的可能性。
