Korean J Ophthalmol.  2016 Jun;30(3):198-205. 10.3341/kjo.2016.30.3.198.

Optical Coherence Tomography-based Diagnosis of Polypoidal Choroidal Vasculopathy in Korean Patients

Affiliations
  • 1Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea.
  • 2Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea. kimoph@gmail.com

Abstract

PURPOSE
To evaluate the efficacy of an optical coherence tomography (OCT)-based diagnosis of polypoidal choroidal vasculopathy (PCV) in Korean patients.
METHODS
This retrospective, observational case series included 263 eyes of 263 patients (147 eyes with PCV and 116 eyes with typical exudative, age-related macular degeneration [AMD]) who had been diagnosed with treatment naïve exudative AMD. Eyes with three or more of the following OCT findings were diagnosed with PCV: multiple retinal pigment epithelial detachment (RPED), a sharp RPED peak, an RPED notch, a hyporeflective lumen representing polyps, and hyperreflective intraretinal hard exudates. The OCT-based diagnosis was compared with the gold-standard indocyanine green angiography-based method. The sensitivity and specificity of the OCT-based diagnosis was also estimated. An additional analysis was performed using a choroidal thickness criterion. Eyes with a subfoveal choroidal thickness greater than 300 µm were also diagnosed with PCV despite having only two OCT features.
RESULTS
In eyes with PCV, three or more OCT features were observed in 126 of 147 eyes (85.7%), and the incidence of typical exudative AMD was 16 of 116 eyes (13.8%). The sensitivity and specificity of an OCT-based diagnosis were 85.7% and 86.2%, respectively. After applying the choroidal thickness criterion, the sensitivity increased from 85.7% to 89.8%, and the specificity decreased from 86.2% to 84.5%.
CONCLUSIONS
The OCT-based diagnosis of PCV showed a high sensitivity and specificity in Korean patients. The addition of a choroidal thickness criterion improved the sensitivity of the method with a minimal decrease in its specificity.

Keyword

Choroidal neovascularization; Diagnosis; Macular degeneration; Optical coherence tomography; Polypoidal choroidal vasculopathy

MeSH Terms

Aged
Choroid/blood supply/*diagnostic imaging
Choroid Diseases/*diagnosis/epidemiology/physiopathology
Diagnosis, Differential
Female
Fluorescein Angiography
Follow-Up Studies
Fundus Oculi
Humans
Incidence
Male
Republic of Korea/epidemiology
Retrospective Studies
Tomography, Optical Coherence/*methods
Visual Acuity

Figure

  • Fig. 1 Representative angiography and optical coherence tomography images in an eye diagnosed with polypoidal choroidal vasculopathy. (A) Fluorescein angiography. (B) Indocyanine green angiography. (C,D) Infrared and (E,F) optical coherence tomography. Multiple retinal pigment epithelial detachment (RPED) (E), sharp RPED peak (E, arrowhead), RPED notch (E, thick arrow), round hyporeflective area representing the polyp lumen (E, thin arrow), and intraretinal hard exudate (F, double arrows) were noted on optical coherence tomography images.

  • Fig. 2 Representative angiography and optical coherence tomography images in an eye diagnosed with polypoidal choroidal vasculopathy. (A) Fluorescein angiography. (B) Indocyanine green angiography. (C,D) Infrared and (E,F) optical coherence tomography. Multiple retinal pigment epithelial detachment (RPED) (E), sharp RPED peak (E, arrowhead), RPED notch (E, thick arrow), round hyporeflective area representing the polyp lumen (F, thin black arrow), and intraretinal hard exudate (F, double arrows) were noted on optical coherence tomography images.

  • Fig. 3 Changes in the logarithm of minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA) in eyes diagnosed with polypoidal choroidal vasculopathy that underwent three consecutive monthly ranibizumab injections as an initial treatment. The closed circles (solid line) indicate the outcome in 111 indocyanine-green angiography-confirmed cases of polypoidal choroidal vasculopathy; the closed squares (dashed line) represent the outcome in 107 eyes diagnosed with the method suggested by De Salvo et al. [7]; the closed triangles (dotted line) suggest the outcome in 113 eyes diagnosed with a modified method, including the choroidal thickness criteria.


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