Gu Xingwang, Zhao Xinyu, Zhao Qing, Wang Yuelin, Chen Youxin
Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
Diagnostics (Basel). 2023 Jul 24;13(14):2458. doi: 10.3390/diagnostics13142458.
The gold standard for polypoidal choroidal vasculopathy (PCV) diagnosis is indocyanine green angiography (ICGA), but optical coherence tomography angiography (OCTA) has shown promise for PCV imaging in recent years. However, earlier generations of OCTA technology lacked the diagnostic efficacy to replace ICGA. Swept-source optical coherence tomography angiography (SS-OCTA), the latest generation of OCTA technology, has significantly improved penetrating ability, scanning speed, scanning range, and overall image quality compared with earlier generations of OCTA. SS-OCTA reveals a "tangled vasculature" pattern of polypoidal lesions (PLs), providing evidence that they are neovascular rather than aneurysmal structures. New choroidal biomarkers, such as the choriocapillaris flow void (FV), have been identified to explain the development of PCV lesions. Although no direct comparison between SS-OCTA and previous OCTA generations in terms of diagnostic capability has been performed, SS-OCTA has shown several advantages in differential diagnosis and monitoring early reactivation for PCV. These improvements make SS-OCTA a valuable tool for PCV diagnosis and follow-up, and it may become more important for this disease in the future. This review summarized recent advances in PCV morphology and structure, as well as the possible pathogenesis based on SS-OCTA findings. The value of SS-OCTA for PCV management is discussed, along with remaining issues, to provide an updated understanding of PCV and OCTA-guided management.
息肉样脉络膜血管病变（PCV）诊断的金标准是吲哚菁绿血管造影（ICGA），但近年来光学相干断层扫描血管造影（OCTA）在PCV成像方面显示出了前景。然而，早期的OCTA技术缺乏取代ICGA的诊断效能。扫频光学相干断层扫描血管造影（SS-OCTA）是最新一代的OCTA技术，与早期的OCTA相比，其穿透能力、扫描速度、扫描范围和整体图像质量都有了显著提高。SS-OCTA显示息肉样病变（PLs）呈“血管缠结”模式，证明它们是新生血管结构而非动脉瘤结构。新的脉络膜生物标志物，如脉络膜毛细血管血流缺失（FV），已被确定用于解释PCV病变的发展。虽然尚未对SS-OCTA与早期几代OCTA的诊断能力进行直接比较，但SS-OCTA在PCV的鉴别诊断和早期再激活监测方面已显示出若干优势。这些改进使SS-OCTA成为PCV诊断和随访的有价值工具，并且在未来对这种疾病可能会变得更加重要。本综述总结了基于SS-OCTA结果的PCV形态和结构的最新进展以及可能的发病机制。讨论了SS-OCTA在PCV管理中的价值以及尚存的问题，以提供对PCV和OCTA引导管理的最新认识。
