| Part One Main findings of polypoidal choroidal vasculopathy in spectral domain optical coherence tomographyPurpose:To investigate the spectral domain optical coherence tomography(SD-OCT)findings in eyes with polypoidal choroidal vasculopathy(PCV).Methods:A single-center,retrospective observational case series study was conducted from Feb 2013 to Dec 2017 at Peking Union Medical College Hospital.The case series included 218 eyes of 203 patients with clinical diagnosis of PCV.The patients underwent color fundus photograph acquisition,SD-OCT,fundus fluorescein angiography(FFA)and indocyanine green angiography(ICGA).Main manifestations and signs on SD-OCT were analyzed.Results:Double layer sign was detected in 160 eyes(78.8%).Pigment epithelial detachment(PED)peak was present in 152 eyes(74.9%).PED notch was seen in 98 eyes(48.2%).Bubble sign was present in 75 eyes(36.9%).PED was detected in 173 eyes(85.2%).Subretinal fluid and inner retinal fliud were seen in 165 eyes(81.2%)and 42 eyes(19.3%).85 eyes(39.4%)had hard exudation.Conclusion:To some extent,SD-OCT could show PCV leisons clearly.When double layer sign,PED peak,PED notch,Bubble sign were seen in SD-OCT,it seems to be related with PCV.Part two Spectral domain optical coherence tomography and optical coherence tomography angiography for the differentiation of polypoidal choroidal vasculopathySection one Spectral domain optical coherence tomography for the differentiation of polypoidal choroidal vasculopathy from wet age-related macular degenerationPurpose:To evaluate the sensitivity and specificity of spectral domain optical coherence tomography(SD-OCT)for the differentiation of PCV from wet age-related macular degeneration(wAMD).Methods:A single-center,retrospective observational case series study was conducted from Jun 2013 to Apr 2017 at Peking Union Medical College Hospital.The case series included 132 eyes of 126 patients with clinical diagnosis of PCV or wAMD.Eyes with three or more of the following SD-OCT findings were diagnosed with PCV:double layer sign(DLS),pigment epithelium detachment(PED),a sharp PED peak,a PED notch and a hyporeflective lumen representing polypoidal lesion.The sensitivity and specificity of the OCT-based diagnosis was estimated.Levels of agreement were determined by ?analyses.Results:Four hundred twety patients(484 eyes)with PCV or wAMD were enrolled in the study.The proportion of DLS(73.3%vs 10.3%),PED(84.0%vs 43.3%),a sharp PED peak(65.5%vs 18.7%),a PED notch(67.7%vs 12.7%),and a hyporeflective lumen representing polypoidal lesion(62.5%vs 6.0%)in eyes with PCV were all higher in eyes with wAMD(P<0.001).SD-OCT detected PCV in 199 of 232 eyes and misdiagnosed wAMD in 28 of 252 eyes.The sensitivity and specificity of SD-OCT for the differentiation of PCV from wAMD were 85.8%and 88.9%,respectively.Agreement was moderate(?=0.747,P<0.001)between SD-OCT and ICGA.Conclusion:SD-OCT-based diagnosis of PCV exhibited high sensitivity and specificity for the differentiation of PCV from wAMD.The presence of at least 3 of 5 SD-OCT findings(DLS,PED,a sharp PED peak,a PED notch,and a hyporeflective lumen representing polypoidal lesion)is suggested to be a new diagnostic strategy for PCV.Section two Evaluating polypoidal choroidal vasculopathy with optical coherencetomography angiographyPurpose:To evaluate the characteristics of polypoidal lesions and abnormal branching vascular network(BVN)in patients with polypoidal choroidal vasculopathy(PCV)by optical coherence tomography angiography(OCTA).Methods:A single-center,retrospective observational case series study was conducted from May 2016 to Apr 2017 at Peking Union Medical College Hospital.The case series included 45 eyes of 42 patients with clinical diagnosis of PCV.All patients underwent ICGA and OCTA.The OCTA images were compared with indocyanine green angiography(ICGA).Detection ratio was used to analyze the polypoidal lesion and the BVN.Results:Ring,circle and cluster like hyper-reflective structues in polypoidal lesions were detected in the en face OCTA images.OCTA demonstrated BVN which was detected by ICGA.Polypoidal lesion was detected by OCTA in 35 of 45(77.8%).While all the BVN in 45 eyes was detected by OCTA.Conclusion:OCTA is a noninvasive imaging tool for detecting vascular changes in PCV.The OCTA patterns of the polypoidal lesion s and BVN are helpful in understanding the pathology of PCVPart three Predictive value of spectral domain optical coherence tomography characteristics in assessment of visual prognosis in eyes with polypoidal choroidal vasculopathyPurpose:To evaluate the spectral domain optical coherence tomography(SD-OCT)characteriscs of polypoidal choroidal vasculopathy and its correlation with the visual acuity after anti-VEGF therapy.Methods:A single-center,retrospective observational case series study was conducted from Jun 2014 to Dec 2017 at Peking Union Medical College Hospital.The case series included 119 eyes of 107 patients with clinical diagnosis of PCV.All patients underwent ICGA,SD-OCT and were examined for best corrected visual acuity(BCVA)before and 12 months after treatment.Patients were divided into 2 groups according to the final visual improvement after 12 months of treatment.The relationship of baseline SD-OCT characteriscs and visual acuity was analyzed.Results:On 12 months after treatment,the BCVA was improved from 0.85 ± 0.53 to 0.70±0.59(t=3.562,P=0.001).The central retinal thickness was changed from 403.51 ±168.52?m to 246.41 ± 101.62?m(t=11.46,P<0.001).Logistic regression analysis showed that the discontinuity of ellipsoid zone(OR=2.527,95%CI:1.733-6.715,P=0.022)or inner retinal fluid(IRF)(OR=2.845,95%CI:1.663-5.138,P=0.041)at baseline was negative prognostic factor to treatment.Conclusion:Existence of IRF or discontinuity of EZ before treatment is negative prognostic factor of final visual improvement for PCV patients. |
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