Choroidal Thickness, Vascular Hyperpermeability, and Complement Factor H in Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy

Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Investigative ophthalmology & visual science (Impact Factor: 3.4). 05/2012; 53(7):3663-72. DOI: 10.1167/iovs.12-9619
Source: PubMed


To investigate the relationship between subfoveal choroidal thickness, choroidal vascular hyperpermeability, and complement factor H (CFH) gene polymorphism in typical age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV).
Fifty-eight patients with typical AMD and 63 patients with PCV underwent fluorescein angiography, indocyanine green angiography (IA), and spectral-domain optical coherence tomography (OCT) using enhanced depth imaging (EDI). Subfoveal choroidal thickness was measured using EDI-OCT images, and choroidal hyperpermeability was evaluated using late-phase IA images. The major AMD-associated single-nucleotide polymorphisms were genotyped in 86 patients.
Mean subfoveal choroidal thickness was significantly lower in eyes with typical AMD than that in eyes with PCV (P = 0.025). Subfoveal choroidal thickness was greater in eyes with choroidal hyperpermeability than that in eyes without it in typical AMD (P < 0.001) and PCV (P = 0.020), and in the fellow eyes of typical AMD (P < 0.001) and PCV (P = 0.027). In eyes without choroidal hyperpermeability, the mean subfoveal choroidal thickness was greater in PCV than that in typical AMD (P = 0.001). Choroidal thickness decreased after photodynamic therapy combined with intravitreal ranibizumab in typical AMD (P = 0.016) and PCV (P = 0.036). In eyes with PCV, the I62V polymorphism in the CFH gene contributed to choroidal thickness (P = 0.043).
Choroidal thickness is related to the AMD subtypes, choroidal hyperpermeability, and I62V CFH gene polymorphism. In eyes without choroidal hyperpermeability, EDI-OCT is useful as an auxiliary measure for differentiating typical AMD and PCV.

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    • "Choroidal thickness varies based on the nature of posterior segment pathology as well. For instance, choroidal thickness increases in hyperopia [24], acute VKH [14,15,18], central serous chorioretinopathy [27,28], and polypoid choroidal vasculopathy [29,30]. On the other hand, loss of choroidal mass has been seen in high myopia [24], age-related macular degeneration [29], macular hole [30], degenerative choroidal disease [31], and ocular inflammation [32]. "
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    ABSTRACT: The aim of this study was to determine the clinical significance of posterior choroidal thickness and vascular changes in the convalescent stage of Vogt-Koyanagi-Harada disease (VKH). Macular spectral domain optical coherence tomography (SD-OCT) images of 22 eyes of 13 consecutive patients with VKH at the convalescent stage were compared to 17 eyes of 9 age/sex/refraction-matched normal subjects. The choriocapillaris layer, medium choroidal vessels (Sattler's layer), and large choroidal vessels (Haller's layer) were assessed in foveal SD-OCT scans. The presence and the extent of disruption of outer retinal structures were also noted. Inner and outer choroid boundaries were manually drawn on horizontal raster SD-OCT scans, and choroidal thickness and volume maps were generated. Correlation analysis was run to assess the association of the above parameters in the VKH patients compared to the normal subjects. In the eyes with convalescent stage of VKH, mean choroidal thickness in the foveal central subfield (200 +/- 60 mum) was lower than in matched controls (288 +/- 40 mum) (P < 0.0001). A thinner sub-macular choroid correlated with a lower visual acuity in uveitis eyes (Pearson correlation, r = -0.5089, P = 0.005). While the choriocapillaris layer was continuous and intact in all control eyes, various degrees of choriocapillaris loss were observed in 11 eyes (50%) with VKH (P < 0.0001). In these patients, the presence of outer retinal disruption was associated with a lower visual acuity (Spearman correlation, P < 0.001). The choroid is significantly thinner and the choriocapillaris layer is disrupted in the eyes with convalescent stage of VKH. Evaluation of the choriocapillaris in SD-OCT scans may be a useful surrogate marker for visual function in the convalescent stage of VKH.
    Journal of Ophthalmic Inflammation and Infection 03/2014; 4(1):9. DOI:10.1186/1869-5760-4-9
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    • "The choroid–sclera interface (CSI) is segmented using a statistical model by Esmaeelpur et al [1]. Pichai Jirarattanasopa investigated the relationship between subfoveal choroidal thickness, and choroidal vascular hyperpermeability [7]. Norberto Mauricio Grzywacz et al. showed a small, but significant correlation between neighbor pixels when measuring OCT intensities with pixels of about 5 µm. "
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    ABSTRACT: The choroid is a densely layer under the retinal pigment epithelium (RPE). Its deeper boundary is formed by the sclera, the outer fibrous shell of the eye. However, the inhomogeneity within the layers of choroidal Optical Coherence Tomography (OCT)-tomograms presents a significant challenge to existing segmentation algorithms. In this paper, we performed a statistical study of retinal OCT data to extract the choroid. This model fits a Gaussian mixture model (GMM) to image intensities with Expectation Maximization (EM) algorithm. The goodness of fit for proposed GMM model is computed using Chi-square measure and is obtained lower than 0.04 for our dataset. After fitting GMM model on OCT data, Bayesian classification method is employed for segmentation of the upper and lower border of boundary of retinal choroid. Our simulations show the signed and unsigned error of -1.44 +/- 0.5 and 1.6 +/- 0.53 for upper border, and -5.7 +/- 13.76 and 6.3 +/- 13.4 for lower border, respectively. © (2014) COPYRIGHT Society of Photo-Optical Instrumentation Engineers (SPIE). Downloading of the abstract is permitted for personal use only.
    Proc. SPIE 9038, Medical Imaging 2014: Biomedical Applications in Molecular, Structural, and Functional Imaging, 90381K, San Diego; 02/2014
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    • "Thus, a measurement of choroidal thickness may provide clues that might help determining not only the effectiveness of IVR but also help determine the pathogenesis of PCV [13,14]. For example, it was reported that the choroidal thickness is related to the AMD subtype, choroidal hyperpermeability, and gene polymorphisms [15-17]. "
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    ABSTRACT: To determine the role played by vascular endothelial growth factor (VEGF) in polypoidal choroidal vasculopathy (PCV) based on an interventional immunology theory. Eyes with PCV were divided in a masked fashion into those with choroidal hyperpermeability (HP group) and those with normal choroidal permeability (NP group) based on the indocyanine green angiograms. The inter-rater agreement rate was evaluated using Fleiss' kappa. Patients were treated by intravitreal ranibizumab (IVB). The central choroidal thickness and central foveal thickness (CFT) at the baseline and 7 days after the treatment were measured by optical coherence tomography. Among the 57 consecutive eyes diagnosed with PCV, 42 eyes of 42 patients met the inclusion criteria (21 eyes/HP group vs 21 eyes /NP group). Central choroidal thickness in HP group was significantly thicker than that in the NP group (P < .001, Mann--Whitney U test). The inter-rater agreement was high with a Fleiss' kappa = 0.95, P < .0001. The percentage reduction in the CFT in HP group (14.0%) was significantly less than that in NP group (20.4%; P = .013, Mann--Whitney U test). Eyes with PCV that are associated with choroidal hyper-permeability may not be strongly associated with VEGF-related pathology, and may not respond favorably to anti-VEGF monotherapy.
    BMC Ophthalmology 08/2013; 13(1):43. DOI:10.1186/1471-2415-13-43 · 1.02 Impact Factor
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