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Acta Ophthalmologica Sep 2021Recent improvements in ophthalmic imaging have led to the identification of a thickened choroid or pachychoroid to be associated with a number of retinal diseases. The... (Review)
Review
Recent improvements in ophthalmic imaging have led to the identification of a thickened choroid or pachychoroid to be associated with a number of retinal diseases. The number of conditions linked to this phenotype has continued to widen with specific endophenotypes found within the pachychoroid spectrum. The spectrum includes choroidal features such as focal or diffuse choroidal thickening and thinning of the overlying inner choroid, and choroidal hyperpermeability as demonstrated by indocyanine green angiography. In addition, these diseases are associated with overlying retinal pigmentary changes and retinal pigment epithelial dysfunction and may also be associated with choroidal neovascularization. This article provides a comprehensive review of the literature looking at diseases currently described within the pachychoroid spectrum including central serous chorioretinopathy, pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy/aneurysmal type 1 neovascularization, peripapillary pachychoroid disease and focal choroidal excavation. We particularly focus on clinical imaging, genetics and pathological findings in these conditions with the aim of updating evidence suggesting a common aetiology between diseases within the pachychoroid spectrum.
Topics: Choroid; Choroid Diseases; Fluorescein Angiography; Fundus Oculi; Humans; Retinal Pigment Epithelium; Tomography, Optical Coherence
PubMed: 33258304
DOI: 10.1111/aos.14683 -
Eye (London, England) Jan 2019Pachychoroid is a relatively novel concept describing a phenotype characterized by attenuation of the choriocapillaris overlying dilated choroidal veins, and associated... (Review)
Review
Pachychoroid is a relatively novel concept describing a phenotype characterized by attenuation of the choriocapillaris overlying dilated choroidal veins, and associated with progressive retinal pigment epithelium dysfunction and neovascularization. The emphasis in defining pachychoroid-related disorders has shifted away from simply an abnormally thick choroid (pachychoroid) toward a detailed morphological definition of a pathologic state (pachychoroid disease) with functional implications, which will be discussed in this review. Several clinical manifestations have been described to reside within the pachychoroid disease spectrum, including central serous chorioretinopathy, pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy/aneurysmal type 1 neovascularization, focal choroidal excavation, peripapillary pachychoroid syndrome. These conditions all exhibit the characteristic choroidal alterations and are believed to represent different manifestations of a common pathogenic process. This review is based on both the current literature and the clinical experience of our individual authors, with an emphasis on the clinical and imaging features, management considerations, as well as current understanding of pathogenesis of these disorders within the context of the recent findings related to pachychoroid disease.
Topics: Choroid; Choroid Diseases; Fluorescein Angiography; Fundus Oculi; Humans; Retinal Pigment Epithelium; Tomography, Optical Coherence
PubMed: 29995841
DOI: 10.1038/s41433-018-0158-4 -
Indian Journal of Ophthalmology Dec 2018A structurally and functionally intact choroid tissue is vitally important for the retina function. Although central retinal artery is responsible to supply the inner... (Review)
Review
A structurally and functionally intact choroid tissue is vitally important for the retina function. Although central retinal artery is responsible to supply the inner retina, choroidal vein network is responsible for the remaining one-third of the external part. Abnormal choroidal blood flow leads to photoreceptor dysfunction and photoreceptor death in the retina, and the choroid has vital roles in the pathophysiology of many diseases such as central serous chorioretinopathy, age-related macular degeneration, pathologic myopia, Vogt-Koyanagi-Harada disease. Biomarkers of choroidal diseases can be identified in various imaging modalities that visualize the choroid. Indocyanine green angiography enables the visualization of choroid veins under the retinal pigment epithelium and choroidal blood flow. New insights into a precise structural and functional analysis of the choroid have been possible, thanks to recent progress in retinal imaging based on enhanced depth imaging (EDI) and swept-source optical coherence tomography (SS-OCT) technologies. Long-wavelength SS-OCT enables the choroid and the choroid-sclera interface to be imaged at greater depth and to quantify choroidal thickness profiles throughout a volume scan, thus exposing the morphology of intermediate and large choroidal vessels. Finally, OCT angiography allows a dye-free evaluation of the blood flow in the choriocapillaris and in the choroid. We hereby review different imaging findings of choroidal diseases that can be used as biomarkers of activity and response to the treatment.
Topics: Choroid; Choroid Diseases; Fluorescein Angiography; Fundus Oculi; Humans; Retinal Pigment Epithelium; Tomography, Optical Coherence
PubMed: 30451172
DOI: 10.4103/ijo.IJO_893_18 -
Vision Research Oct 2017Early histopathological studies of diabetic choroids demonstrated loss of choriocapillaris (CC), tortuous blood vessels, microaneurysms, drusenoid deposits on Bruchs... (Review)
Review
Early histopathological studies of diabetic choroids demonstrated loss of choriocapillaris (CC), tortuous blood vessels, microaneurysms, drusenoid deposits on Bruchs membrane, and choroidal neovascularization. The preponderance of histopathological changes were at and beyond equator. Studies from my lab suggest that diabetic choroidopathy is an inflammatory disease in that leukocyte adhesion molecules are elevated in the choroidal vasculature and polymorphonuclear neutrophils are often associated with sites of vascular loss. Modern imaging techniques demonstrate that blood flow is reduced in subfoveal choroidal vasculature. Angiography has shown areas of hypofluorescence and late filling that probably represent areas of vascular loss and/or compromise. Perhaps, as a result of vascular insufficiency, the choroid appears to thin in DC unless macular edema is present. Enhanced depth imaging (EDI-SD) OCT and swept source (SS) OCT have documented the tortuosity and loss in intermediate and large blood vessels in Sattler's and Haller's layer seen previously with histological techniques. The risk factors for DC include diabetic retinopathy, degree of diabetic control, and the treatment regimen. In the future, OCT angiography could be used to document loss of CC. Because most of the measurement and imaging are in the posterior pole, the severity of DC may be underappreciated in the published accounts of DC assessed with imaging techniques. However, it is now possible to document DC and quantify these changes clinically. This suggests that DC should be evaluated in future clinical trials of drugs targeting DR because vascular changes similar to those in DR are occurring in DC.
Topics: Choroid; Choroid Diseases; Diabetes Complications; Humans; Neutrophils; Tomography, Optical Coherence
PubMed: 28535994
DOI: 10.1016/j.visres.2017.04.011 -
Retina (Philadelphia, Pa.) Jul 2017To review the current literature on robotic assistance for ophthalmic surgery, especially vitreoretinal procedures. (Review)
Review
PURPOSE
To review the current literature on robotic assistance for ophthalmic surgery, especially vitreoretinal procedures.
METHODS
MEDLINE, Embase, and Web of Science databases were searched from inception to August, 2016, for articles relevant to the review topic. Queries included combinations of the terms: robotic eye surgery, ophthalmology, and vitreoretinal.
RESULTS
In ophthalmology, proof-of-concept papers have shown the feasibility of performing many delicate anterior segment and vitreoretinal surgical procedures accurately with robotic assistance. Multiple surgical platforms have been designed and tested in animal eyes and phantom models. These platforms have the capability to measure forces generated and velocities of different surgical movements. "Smart" instruments have been designed to improve certain tasks such as membrane peeling and retinal vessel cannulations.
CONCLUSION
Ophthalmic surgery, particularly vitreoretinal surgery, might have reached the limits of human physiologic performance. Robotic assistance can help overcome biologic limitations and improve our surgical performance. Clinical studies of robotic-assisted surgeries are needed to determine safety and feasibility of using this technology in patients.
Topics: Animals; Choroid Diseases; Humans; Retinal Diseases; Robotic Surgical Procedures; Vitreoretinal Surgery
PubMed: 27893625
DOI: 10.1097/IAE.0000000000001398 -
Acta Ophthalmologica Scandinavica Sep 2007Hypotony maculopathy, first described in 1954 by Dellaporta, usually occurs after antiglaucomatous surgery or after perforating eye injuries; it is characterized by... (Review)
Review
Hypotony maculopathy, first described in 1954 by Dellaporta, usually occurs after antiglaucomatous surgery or after perforating eye injuries; it is characterized by hypotony associated with fundus abnormalities, including papilloedema, vascular tortuosity and chorioretinal folds. In hypotony maculopathy, the scleral wall collapses inward, resulting in redundancy of the choroid and retina, leading to chorioretinal wrinkling. As the antero-posterior diameter of the vitreous cavity decreases, the very thick perivofeal retina surrounding the very thin foveal retina is thrown into radial folds around the fovea. It has been reported that hypotony maculopathy occurs in up to 20% of cases of glaucoma filtering surgery and has become more common after the introduction of antimetabolites. Young age, myopia, primary filtering surgery, systemic illnesses and elevated preoperative intraocular pressure (IOP) have been found to be associated with hypotony maculopathy. Hypotony maculopathy is treated with procedures designed to elevate IOP, which may reverse the inward scleral bowing and improve visual acuity. The successful treatment of hypotony maculopathy depends on the correct identification of its cause. Once the cause is detected, treatment should be employed as soon as possible because delayed normalization of the IOP may result in permanent macular chorioretinal changes and poor vision. This review will explore the definition, mechanisms, clinical findings and treatment of hypotony maculopathy.
Topics: Choroid Diseases; Humans; Incidence; Intraocular Pressure; Microscopy, Acoustic; Ocular Hypotension; Papilledema; Retinal Diseases; Risk Factors; Tomography, Optical Coherence
PubMed: 17542978
DOI: 10.1111/j.1600-0420.2007.00910.x -
Arquivos Brasileiros de Oftalmologia 2015Birdshot retinochoroidopathy (BSRC) is a distinct type of posterior uveitis originally described in the 1940s. Its characteristics include minimal anterior segment... (Review)
Review
Birdshot retinochoroidopathy (BSRC) is a distinct type of posterior uveitis originally described in the 1940s. Its characteristics include minimal anterior segment inflammation and diffuse posterior choroidopathy with vitritis and retinal vasculitis. The precise etiology of this disease is yet to be elucidated. However, various treatment modalities have been employed with the ultimate goal of durable remission of this vision threatening intraocular disease. The purpose of this review is not only to emphasize the importance of recognizing BSRC, but also to discuss the new discoveries, immune mediators, current and new therapies, and techniques applied to monitor and accomplish disease remission.
Topics: Antibodies, Monoclonal, Humanized; Chorioretinitis; Choroid Diseases; Diagnosis, Differential; Drug Therapy, Combination; Electroretinography; Fluorescein Angiography; HLA-A Antigens; Humans; Immunosuppressive Agents; Remission Induction; Retinal Diseases
PubMed: 25714542
DOI: 10.5935/0004-2749.20150016 -
Investigative Ophthalmology & Visual... Aug 2022To investigate the distribution of hyperreflective choroidal foci (HCF) in eyes with Vogt-Koyanagi-Harada (VKH) disease.
PURPOSE
To investigate the distribution of hyperreflective choroidal foci (HCF) in eyes with Vogt-Koyanagi-Harada (VKH) disease.
METHODS
We included 22 eyes of 11 patients with VKH disease in the convalescent stages and 22 eyes of age- and sex-matched normal controls. HCF were quantified using en face optical coherence tomography (OCT) images of the choroid, and the degree of fundus pigmentation was determined by the color balance of the fundus photographs. The results were then analyzed between the eyes with and without sunset glow fundus (SGF).
RESULTS
The median age of patients with VKH disease was 58.0 (range 54.0-65.0) years, and median disease duration was 66.4 (range 8.5-147.7) months. In 22 eyes with VKH, the number and total area of HCF were correlated with the degree of fundus pigmentation (ρ = -0.671, P < 0.001; ρ = -0.612, P = 0.002, respectively). The number of HCF was significantly smaller in VKH disease-affected eyes with SGF (median, interquartile range; 134.6, 110.0-159.2) than in those without SGF (229.0, 197.0-261.0) and the eyes of normal controls (211.8, 190.3-233.4).
CONCLUSIONS
HCF distributions correlated with the degree of fundus pigmentation in eyes with VKH disease. Quantitative measurements of HCF on en face OCT images can be a novel tool in evaluating choroidal pigmentation in patients with VKH disease.
Topics: Child, Preschool; Choroid; Choroid Diseases; Fluorescein Angiography; Humans; Retrospective Studies; Tomography, Optical Coherence; Uveomeningoencephalitic Syndrome; Visual Acuity
PubMed: 36006654
DOI: 10.1167/iovs.63.9.27 -
Retina (Philadelphia, Pa.) Sep 2018To describe the features of peripapillary pachychoroid syndrome (PPS), a novel pachychoroid disease spectrum (PDS) entity. (Observational Study)
Observational Study
PURPOSE
To describe the features of peripapillary pachychoroid syndrome (PPS), a novel pachychoroid disease spectrum (PDS) entity.
METHODS
Medical records of 31 eyes (16 patients) with choroidal thickening associated with intraretinal and/or subretinal fluid in the nasal macula extending from the disk were reviewed (patients with PPS). Choroidal thickness was compared with 2 age-matched cohorts: typical PDS (17 eyes with central serous chorioretinopathy or pachychoroid neovasculopathy) and 19 normal eyes.
RESULTS
The patients with PPS were 81% men aged 71 ± 7 years. Peripapillary pachychoroid syndrome eyes displayed thicker nasal versus temporal macular choroids, unlike PDS eyes with thicker temporal macular choroids (P < 0.0001). Peripapillary intraretinal and/or subretinal fluid was often overlying dilated Haller layer vessels (pachyvessels). Fundus autofluorescence and fluorescein angiography illustrated peripapillary pigmentary mottling without focal leakage. Most PPS eyes (70%) exhibited other PDS findings including serous pigment epithelial detachment or gravitational tracks. Indocyanine green angiography illustrated dilated peripapillary pachyvessels and choroidal hyperpermeability. The disk was usually crowded, with edema noted in 4/31 (13%) eyes and mild late fluorescein disk leakage identified in half of the cases. Choroidal folds (77%), short axial lengths (39% less than 23 mm), and hyperopia (86%) were common.
CONCLUSION
Peripapillary pachychoroid syndrome is a distinct PDS variant, in which peripapillary choroidal thickening is associated with nasal macular intraretinal and/or subretinal fluid and occasional disk edema. Recognition of PPS is important to distinguish it from disorders with overlapping features such as posterior uveitis and neuro-ophthalmologic conditions.
Topics: Aged; Aged, 80 and over; Choroid; Choroid Diseases; Female; Fluorescein Angiography; Follow-Up Studies; Fundus Oculi; Humans; Macula Lutea; Male; Middle Aged; Optic Disk; Retrospective Studies; Syndrome; Tomography, Optical Coherence
PubMed: 29135799
DOI: 10.1097/IAE.0000000000001907 -
Indian Journal of Ophthalmology Dec 2018
Topics: Choroid Diseases; Eye Diseases, Hereditary; Fluorescein Angiography; Fundus Oculi; Humans; Multimodal Imaging; Retinal Degeneration; Tomography, Optical Coherence; Visual Acuity; Vitreoretinal Surgery
PubMed: 30451160
DOI: 10.4103/ijo.IJO_1894_18