Quantitative Assessment of Asymmetric Choroidal Outflow in Pachychoroid Eyes on Ultra-Widefield Indocyanine Green Angiography

• Published in: Investigative ophthalmology & visual science 2020-07, Vol.61 (8), p.50-50
• Main Authors: Jung, Jesse J, Yu, Daryle Jason G, Ito, Kazuyo, Rofagha, Soraya, Lee, Scott S, Hoang, Quan V
• Format: Article
• Language: English
• Subjects: Central Serous Chorioretinopathy - diagnosis; Central Serous Chorioretinopathy - physiopathology; Choroid - blood supply; Coloring Agents - pharmacology; Female; Fluorescein Angiography - methods; Humans; Indocyanine Green - pharmacology; Male; Middle Aged; Multimodal Imaging - methods; Reproducibility of Results; Retina; Veins - pathology; Veins - physiopathology; Visual Acuity
• ISSN: 1552-5783; 0146-0404; 1552-5783
• DOI: 10.1167/iovs.61.8.50

To quantitatively demonstrate asymmetric choroidal outflow in pachychoroid (central serous chorioretinopathy [CSC]/pachychoroid pigment epitheliopathy [PPE]) eyes using mid-phase, ultra-widefield indocyanine green angiography (UWF ICGA) images. Eyes with a clinical diagnosis of CSC/PPE were imaged with multimodal imaging including UWF ICGA (Optos California). Quadrant brightness was measured by manually segmenting based on vortex vein location, calculating the brightness "max-min" value to assess nonuniformity between quadrants, and comparing between CSC/PPE and control eyes. A multivariate linear regression was performed to determine, across individual eyes, which specific quadrants have the greatest brightness in pachychoroid eyes, after taking into account patient-eye-specific variability. Thirty-three eyes (18 patients) with CSC/PPE along with 16 eyes of 9 controls had a mean age of 51.94 ± 9.72 vs. 53.78 ± 17.92 years (P = 0.731), respectively. Max-min analysis showed significantly increased likelihood of nonuniform drainage between vortex veins in both CSC/PPE and control eyes. Multivariate linear regression in control eyes showed that on average, the inferotemporal quadrant was significantly brighter than the superonasal quadrant (9.72 units, P < 0.001). Among CSC/PPE eyes, adjusting for the preferential, nonuniform drainage in control eyes, the inferonasal and inferotemporal quadrants in CSC/PPE eyes remained significantly brighter than the reference quadrant by 5.36 units (P = 0.034) and 7.51 units (P = 0.008), respectively. Asymmetric choroidal venous outflow occurs in both control and CSC/PPE eyes based on UWF ICGA quantitative brightness levels in each quadrant. Increased brightness levels along inferior quadrants in mid-phase ICGA images suggest venous outflow congestion among eyes with CSC or PPE.