A Preliminary Study On The Classification Of Polypoid Choroidal Vascular Disease

Part I Choroidal morphology and vascular features in two subtypes of polypoidal choroidal vasculopathyPurpose:To analyze the choroidal morphological features of polypoidal choroidal vasculopathy(PCV)by SD-OCT,and to classify PCV into tow subtypes based on subfoveal choroidal thickness.Methods:This is a retrospective cohort study of 64 untreated patients(64 eyes)with PCV who were enrolled from July 2015 to December 2017.The enhanced depth imaging of SD-OCT examination was performed at baseline.Research indicators including subfoveal choroidal thickness(SFCT),Choroidal thickness differencial ratio(CTDR),and maximum vascular diameter ratio(MVDR).ImageJ software was used to process the OCT images and calculate the intravascular area ratio(VAR)within 1.5 mm and 6.0 mm of the macular fovea.Eyes of PCV were classified according to SFCT and the two subtypes were compared.Results:The average age of 64 patients was 64.0±7.5 years and 40 of them were men(62.5%).The average SFCT was 233.2±80.7 ?m(range:84-412 ?m).The distribution of SFCT was bimodal,and the median 225 ?m between the two peaks of SFCT was taken as the cutoff for two subtypes in this study.MVDR,1.5 mm and 6.0 mm VAR were statistically different between thick PCV group and thin PCV group(P values were 0.02,<0.001,<0.001,respectively).CTDR was not statistically different between the two groups(P=0.097).Conclusions:SFCT can be used as an indicator to classify PCV subtypes.Choroidal vessels in the thick PCV group were dilated and the vasular area is increased.The thin PCV group didn't have these features.Both subtypes of choroidal contours have indistinguishable pathological variations.Part II Systemic and Ocular Risk Factors for Polypoidal Choroidal Vasculopathy and subtypes in ChinesePurpose:To evaluate potential risk factors for polypoidal choroidal vasculopathy(PCV)and differences in potential risk factors for PCV subtypes..Methods:This is a retrospective case-control study.64 patients(64 eyes)of naive PCV in our hospital from July 2015 to December 2017 were enrolled and are classified into thick PCV and thin PCV(SFCT = 225 ?m was used as the cutoff point).42 patients(42 eyes)who had undergone cataract surgery in our hospital from January 2016 to December 2017 were collected as control.A detailed history of all subjects were collected,including:age,gender,best corrected visual acuity(BCVA),hypertension,dyslipidemia,cardiovascular disease,ever-smoking history,alcohol consumption,and axial length.Univariate analysis and Logistic regression analysis were used to analyze the potential risk factors between PCV group and control group and differences in two PCV subgroups.Results:Univariate analysis showed that PCV had a greater age(P=0.046),a higher incidence of hypertension(P=0.021),a greater proportion of smokers(P=0.036),and a shorter axial length(P=0.003).There was no statistical difference in dyslipidemia,cardiovascular disease and alcohol consumption between the two groups.Logistic regression showed that age,hypertension,ever-smoking history,and axial length were still statistically significant.Comparison between thick PCV and control group revealed a statistically significant difference in hypertension,ever-smoking history,and axial length(P = 0.03,0.006,0.001,respectively).Comparison between thin PCV and control group revealed that there was a statistically significant difference between age,ever-smoking history and axial length(P values were<0.001,0.005,0.019,respectively).Thick PCV and thin PCV had statistically significant differences only in age and axial length(P = 0.005 and 0.019,respectively).Conclusions:This study showed that age,hypertension,ever-smoking history,and axial length are potential risk factors for PCV.In subtypes of PCV,thick PCV was younger and had a shorter axial length than thin PCV,but systemic systemic risk factors were similar between the two subtypes.Part III Comparison of OCT and ICGA findings with subtypes of polypoidal choroidal vasculopathyPurpose:To compare OCT and ICGA findings of PCV subtypes divided by subfoveal choroidal thickness.Methods:This is a retrospective cohort study.64 PCV patients(64 eyes)in our hospital from July 2015 to December 2017 were enrolled and classified to thick PCV and thin PCV according to SFCT.OCT and FFA+ICGA examinations performed at baseline were analyzed,and parameters of the two subtypes were univariately compared.Results:The mean logMAR BCVA of thick PCV and thin PCV were 0.58 ± 0.28 and 0.86 ± 0.43,respectively.There was a statistically significant difference between the two subtypes.Imaging parameters including number of polyps,BVN area,maximum linear dimension of lesion(GLD),choroidal vascular hyperpermeability(CVH),central macular thickness(CMT),subfoveal choroidal thickness(SFCT),presence of PED,and PED Diameter were statistically different in the two subtypes of PCV(P values were<0.001,<0.001,0.03,<0.001,0.016,0.048,<0.001,0.038 and 0.022,respectively).There was no statistical difference of PED type and PED height and fellow eye status between the two subtypes of PCV(P values were 0.154,0,982,and 0.677,respectively).Conclusions:Thick PCV has less numbers of polyps,smaller BVN area,smaller lesion size,less appearance of PED,smaller PED diameter,smaller CMT and large proportion of CVH than thin PCV.The differences of clinical and imaging features is similar to Typical PCV and Polypoidal CNV subtypes.The development of multimodal imaging technology is helpful for the diagnosis and classification of PCV.Part IV Factors predictive of outcomes 1 year after 3 monthly anti-VEGF injections and as needed reinjection for polypoidal choroidal vasculopathy in Chinese patientsPurpose:To analyze the correlation between baseline factors and best corrected visual acuity(BCVA)change after 3 monthly anti-VEGF therapy in naive PCV.Methods:This is a retrospective cohort study.44 PCV patients(44 eyes)treated in our hospital from July 2015 to December 2017 were enrolled.BCVA,OCT and FFA + ICGA examinations were done at baseline.All patients were treated with monthly anti-VEGF(including ranibizumab and conbercept)injections for 3 consecutive months after diagnosis,followed by as needed retreatment,BCVA at 12th follow-up after the first anti-VEGF treatment was recorded and compared with baseline BCVA.BCVA changes were divided into improved and unimproved groups.Univariate and logistic regression analysis was used to analyze the correlation between between baseline factors and BCVA change.Results:The univariate analysis showed that the improved group had shorter time of onset,smaller greatest linear dimension(P = 0.045 and 0.037,respectively).Logistic regression showed choroidal vascular hyperpermeability(CVH)and greatest linear dimension(GLD)was statistically significant and was an independent predictor of visual outcome(regression coefficients were 0.963 and 0.001;P values were 0.010 and 0.012;odds ratios were 0.083 and 1.002;95%confidence interval were 0.013-0.549 and 1.001-1.004).Conclusions:CVH may be a predictor of poor visual acuity prognosis in PCV treated with anti-VEGF.GLD and time of onset were also related to visual acuity prognosis in PCV treated with anti-VEGF.