Pachychoroid neovasculopathy: aspect on optical coherence tomography angiography.
OBJECTIVE
To describe and interpret the features of pachychoroid neovasculopathy (PNV) using optical coherence tomography angiography (OCTA) technique.


METHODS
This is an observational case series of patients who presented with PNV. Best-corrected visual acuity (BCVA), anterior segment examination, dilated funduscopic examination, infrared and autofluorescence fundus images and spectral-domain optical coherence tomography (SD-OCT; B-scan, 'en-face' and OCTA) were carried out for all patients. Choroid thickness was measured using enhanced depth imaging (EDI) mode. Colour fundus photographs, fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were not performed systematically. Optical coherence tomography angiography (OCTA) features of PNV are described and interpreted.


RESULTS
Five eyes of five patients with a mean age of 62.2 years (range, 53-73 years) presenting with PNV were analysed. They all presented pachychoroid pigment epitheliopathy (PPE) with choroidal thickening and dilated choroidal vessels as seen with EDI-OCT. Fluorescein angiography (FFA) was performed in three patients showing multiple areas of retinal pigment epithelium atrophy and fundus lesions suggestive of chronic central serous chorioretinopathy. Indocyanine green angiography (ICGA) in one patient confirmed the presence of large choroidal veins and choroidal hyperpermeability seen beneath the area of the neovascular tissue. Two eyes had the appearance of polypoidal structures within the neovascular tissue, with the characteristic aspect of the polypoidal lesions on B-scan and 'en-face'. Optical coherence tomography angiography (OCTA) showed the appearance of tangled filamentous vascular network in all eyes.


CONCLUSIONS
Optical coherence tomography angiography (OCTA) is a safe, highly sensitive and specific examination for the detection of type 1 neovascularization associated with PPE. Features are characteristic of tangled filamentous vessels overlying a focal area of thickened choroid.
Eye & Ear Hospital International, Beirut, Lebanon.|Faculty of Medicine, Holy Spirit University of Kaslik (USEK), Kaslik, Lebanon.|Faculty of Medicine, Saint Joseph University (USJ), Beirut, Lebanon.
Georges
G
Azar
Rothschild Ophthalmological Foundation, Paris Cedex, France.
Benjamin
B
Wolff
Rothschild Ophthalmological Foundation, Paris Cedex, France.
Martine
M
Mauget-Faÿsse
Italian Macula Center, Rome, Italy.
Marco
M
Rispoli
Italian Macula Center, Rome, Italy.
Maria-Cristina
MC
Savastano
Italian Macula Center, Rome, Italy.
Bruno
B
Lumbroso
D000368:Aged; D056833:Central Serous Chorioretinopathy / Q000175:diagnosis*; D002829:Choroid / Q000473:pathology*; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods*; D005654:Fundus Oculi; D006801:Humans; D008297:Male; D008875:Middle Aged; D055213:Retinal Pigment Epithelium / Q000473:pathology; D041623:Tomography, Optical Coherence / Q000379:methods*; D014792:Visual Acuity
choroidal neovascularization; chronic central serous chorioretinopathy; optical coherence tomography angiography; pachychoroid neovasculopathy; pachychoroid pigment epitheliopathy