PMID- 30998817 OWN - NLM STAT- MEDLINE DCOM- 20200221 LR - 20200309 IS - 2168-6173 (Electronic) IS - 2168-6165 (Print) IS - 2168-6165 (Linking) VI - 137 IP - 6 DP - 2019 Jun 1 TI - Appearance of Polypoidal Lesions in Patients With Polypoidal Choroidal Vasculopathy Using Swept-Source Optical Coherence Tomographic Angiography. PG - 642-650 LID - 10.1001/jamaophthalmol.2019.0449 [doi] AB - IMPORTANCE: Polypoidal choroidal vasculopathy (PCV) is a major cause of visual loss worldwide, particularly in Asia, and the appropriate understanding of the structures in PCV previously described as polypoidal lesions is important for understanding their pathogenesis, diagnosis, and prognosis. OBJECTIVE: To report the morphologic characteristics of polypoidal lesions and their association with branching vascular networks (BVNs) in eyes with PCV using swept-source optical coherence tomographic angiography (SS-OCTA). DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional observational study included 20 participants recruited from Shanghai General Hospital with a diagnosis of PCV based on the presence of focal hyperfluorescent spots on indocyanine green angiography (ICGA). Data were collected from December 1, 2017, to September 1, 2018, and analyzed from June 1 through September 30, 2018. MAIN OUTCOMES AND MEASURES: Polypoidal lesions in eyes with PCV were characterized using multimodal imaging that included fundus photography, fluorescein angiography, ICGA, SS-OCT, and SS-OCTA, and the images were anatomically aligned. Subfoveal choroidal thickness was manually measured as the distance between the Bruch membrane and the sclerochoroidal interface on the SS-OCT images. RESULTS: Of the 20 Asian patients, 5 (25%) were women and 15 (75%) were men. The mean (SD) age was 61.1 (7.6) years, and the mean (SD) logMAR visual acuity was 0.358 (0.294) (Snellen equivalent, 20/50 [20/40]). Twenty-three eyes underwent imaging and were diagnosed with PCV. Indocyanine green angiography identified 43 polypoidal lesions, and all corresponded to the structures that appeared as clusters of tangled vessels on SS-OCTA images. In addition, SS-OCTA detected 16 tangled vascular structures not seen on ICGA. Branching vascular networks were detected on SS-OCTA imaging in all eyes, but ICGA identified BVNs in only 17 of 23 eyes (74%). Of the 43 tangled vascular structures, 40 (93%) were located at the edge of a BVN and 3 (7%) were associated with type 2 neovascularization. CONCLUSIONS AND RELEVANCE: In eyes with PCV undergoing SS-OCTA imaging, previously described polypoidal lesions may appear as tangled vascular structures associated with BVN or type 2 neovascularization. The identification of polypoidal lesions in patients with PCV as neovascular tangles rather than actual polypoidal lesions or aneurysmal dilatations may help facilitate understanding of their pathogenesis and response to treatment. FAU - Bo, Qiyu AU - Bo Q AD - Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China. AD - Shanghai Key Laboratory of Fundus Diseases, Shanghai, China. FAU - Yan, Quan AU - Yan Q AD - Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China. AD - Shanghai Key Laboratory of Fundus Diseases, Shanghai, China. FAU - Shen, Mengxi AU - Shen M AD - Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China. AD - Shanghai Key Laboratory of Fundus Diseases, Shanghai, China. FAU - Song, Minlu AU - Song M AD - Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China. AD - Shanghai Key Laboratory of Fundus Diseases, Shanghai, China. FAU - Sun, Mengsha AU - Sun M AD - Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China. AD - Shanghai Key Laboratory of Fundus Diseases, Shanghai, China. FAU - Yu, Yang AU - Yu Y AD - Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China. FAU - Rosenfeld, Philip J AU - Rosenfeld PJ AD - Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida. FAU - Wang, Fenghua AU - Wang F AD - Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China. AD - Shanghai Key Laboratory of Fundus Diseases, Shanghai, China. AD - Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China. FAU - Sun, Xiaodong AU - Sun X AD - Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China. AD - Shanghai Key Laboratory of Fundus Diseases, Shanghai, China. AD - Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China. LA - eng PT - Case Reports PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - JAMA Ophthalmol JT - JAMA ophthalmology JID - 101589539 RN - 0 (Angiogenesis Inhibitors) RN - 0 (Coloring Agents) RN - 0 (VEGFA protein, human) RN - 0 (Vascular Endothelial Growth Factor A) RN - IX6J1063HV (Indocyanine Green) RN - ZL1R02VT79 (Ranibizumab) SB - IM CIN - JAMA Ophthalmol. 2019 Jun 1;137(6):650-651. PMID: 30998815 MH - Aged MH - Angiogenesis Inhibitors/therapeutic use MH - Choroid/*blood supply MH - Choroidal Neovascularization/*diagnostic imaging/drug therapy MH - Coloring Agents/administration & dosage MH - Cross-Sectional Studies MH - Female MH - Fluorescein Angiography MH - Humans MH - Indocyanine Green/administration & dosage MH - Intravitreal Injections MH - Male MH - Middle Aged MH - Polyps/*diagnostic imaging/drug therapy MH - Ranibizumab/therapeutic use MH - Tomography, Optical Coherence/methods MH - Vascular Endothelial Growth Factor A/antagonists & inhibitors PMC - PMC6567849 COIS- Conflict of Interest Disclosures: Dr Rosenfeld reported receiving grants and personal fees from Carl Zeiss Meditec, Inc, outside the submitted work. Dr Wang reported receiving grants from National Natural Science Foundation of China during the conduct of the study and grants from Carl Zeiss Meditec, Inc, outside the submitted work. No other disclosures were reported. EDAT- 2019/04/19 06:00 MHDA- 2020/02/23 06:00 PMCR- 2019/04/18 CRDT- 2019/04/19 06:00 PHST- 2019/04/19 06:00 [pubmed] PHST- 2020/02/23 06:00 [medline] PHST- 2019/04/19 06:00 [entrez] PHST- 2019/04/18 00:00 [pmc-release] AID - 2731479 [pii] AID - eoi190013 [pii] AID - 10.1001/jamaophthalmol.2019.0449 [doi] PST - ppublish SO - JAMA Ophthalmol. 2019 Jun 1;137(6):642-650. doi: 10.1001/jamaophthalmol.2019.0449.