Classification of Exudative Age-Related Macular Degeneration With Pachyvessels on En Face Swept-Source Optical Coherence Tomography

• Published in: Investigative ophthalmology & visual science 2017-02, Vol.58 (2), p.1054-1062
• Main Authors: Ng, Danny Siu-Chun, Bakthavatsalam, Malini, Lai, Frank Hiu-Ping, Cheung, Carol Yim-Lui, Cheung, Gemmy Chu-Ming, Tang, Fang Yao, Tsang, Chi Wai, Lai, Timothy Yuk-Yau, Wong, Tien Yin, Brelén, Mårten Erik
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cross-Sectional Studies; Female; Fluorescein Angiography - methods; Follow-Up Studies; Fundus Oculi; Humans; Male; Middle Aged; Reproducibility of Results; Retinal Pigment Epithelium - pathology; Retinal Vessels - pathology; Retrospective Studies; Tomography, Optical Coherence - methods; Visual Acuity; Wet Macular Degeneration - classification; Wet Macular Degeneration - diagnosis
• ISSN: 1552-5783; 1552-5783
• DOI: 10.1167/iovs.16-20519

The purpose of this study was to classify exudative maculopathy by the presence of pachyvessels on en face swept-source optical coherence tomography (SSOCT). Consecutive patients with signs of exudative maculopathy underwent SSOCT, fluorescein and indocyanine green angiography (ICGA), ultra-widefield fundus color photography, and autofluorescence examinations. Images were analyzed in a masked fashion by two sets of four examiners in different sessions: (1) the presence of pachyvessels in en face OCT and (2) features of exudative maculopathy in conventional imaging modalities. Quantitative data obtained were subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI), which was the ratio of choroidal vessels lumen area to a specified choroidal area from binarized cross-sectional OCT scans. Pachyvessels was observed in 38 (52.1%) of 73 eyes. The pachyvessels group was associated with younger age (69.1 ± 9.4 years, odds ratio [OR] = 0.95, 95% confidence interval [95% CI] = 0.90-0.97, P = 0.04), presence of polypoidal lesions (OR = 3.27, 95% CI = 1.24-8.62, P = 0.01), increased SFCT (OR = 1.08, 95% CI = 1.02-1.14, P < 0.01), and increased CVI (65.4 ± 5.3, OR = 1.12, 95% CI = 1.02-1.23, P = 0.01). In multivariate regression, CVI significantly correlated with pachyvessels (OR = 1.24, 95% CI = 1.03-1.55, P = 0.04). Exudative maculopathy could be classified based on differences in choroidal vasculature morphology. Current results implied that choroidal hemodynamics may be relevant to variable natural history and treatment response in neovascular AMD and polypoidal choroidal vasculopathy.