Original Paper
Ophthalmologica
Ophthalmologica 2014;231:221–225 DOI: 10.1159/000357114
Received: July 19, 2013 Accepted after revision: October 30, 2013 Published online: March 5, 2014
Choroidal Thickness in Idiopathic Subfoveal Choroidal Neovascularization Xu-Sheng Cao a Xiao-Yan Peng b Qi-Sheng You b Yong-Peng Zhang a Jost B. Jonas b, c a Department of Ophthalmology and b Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China; c Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University, Heidelberg, Germany
Key Words Choroidal thickness · Enhanced depth imaging · Optical coherence tomography · Choroidal neovascularization
Abstract Purpose: To evaluate choroidal thickness in patients with idiopathic choroidal neovascularization. Methods: The observational case series study included patients who were consecutively diagnosed with idiopathic unilateral choroidal neovascularization as demonstrated by ophthalmoscopy, fluorescein angiography and enhanced depth imaging optical coherence tomography (EDI-OCT). Using EDI-OCT, choroidal thickness was measured at the fovea and at locations in a distance of 500, 1,000 and 1,500 μm temporal and nasal to the fovea. Results: Mean subfoveal choroidal thickness was significantly (p = 0.002) thicker in the study group than in the control group (357 ± 99 vs. 316 ± 83 μm). In a parallel manner, the differences between the study group and the control group in choroidal thickness were significant for all other measurement points, except for the examination at 1,500 μm nasal to the fovea (p = 0.09). The results remained unchanged after adjusting for axial length and age. Conclusions: Idiopathic unilateral choroidal neovascularization is associated with a thickening of the choroid. © 2014 S. Karger AG, Basel
© 2014 S. Karger AG, Basel 0030–3755/14/2314–0221$39.50/0 E-Mail [email protected] www.karger.com/oph
Introduction
Idiopathic subfoveal choroidal neovascularization (ISCNV) is defined as subfoveal choroidal neovascularization occurring in patients younger than 50 years who do not have evidence of any macular or retinal disease potentially associated with subfoveal choroidal neovascularization. These diseases include age-related macular degeneration, myopic retinopathy, presumed histoplasmosis syndrome, angioid streaks and inflammatory, traumatic or hereditary disorders [1]. Although ISCNV has a relatively favorable prognosis compared to subfoveal choroidal neovascularization in diseases such as exudative age-related macular degeneration or polypoidal choroidal vasculopathy, severe visual loss can occur at a relatively young age [2, 3]. While the pathomechanism of subfoveal choroidal neovascularization in other disorders has been intensively explored, few studies have focused on the mechanism of ISCNV [4–6]. The choroid receives approximately 95% of all ocular blood flow and is primarily or secondarily involved in the pathogenesis of many diseases of the posterior segment of the eye [7–10]. The choroidal thickness can be measured by the technique of enhanced depth imaging by spectral domain optical coherence tomography (EDI-OCT) which was recently described by Spaide et al. [11] and Margolis and Spaide [12]. Previous studies have reported that some diseases, such Prof. X.-Y. Peng Beijing Institute of Ophthalmology 17 Hougou Lane, Chongnei Street Beijing 100005 (China) E-Mail drpengxy @ 163.com
Fig. 1. Cross-sectional imaging of the cho-
roid using EDI-OCT. Choroidal thickness was measured at 500, 1,000 and 1,500 μm temporal and nasal to the fovea.
as central serous choroidoretinopathy and polypoidal choroidal vasculopathy, are associated with an abnormally thick choroid while other disorders such as myopic retinopathy have an abnormally thin choroid [7–10, 13, 14]. Since an abnormal thickness of the choroid may allow conclusions on the pathogenesis and may be helpful for the diagnosis of ISCNV, we designed this study to assess choroidal thickness in active ISCNV.
Methods This prospective clinical observational study included patients in whom an active idiopathic unilateral choroidal neovascularization was consecutively diagnosed in the Beijing Tongren Hospital between August and December 2012. The contralateral unaffected eyes served as control group. The study followed the tenets of the Declaration of Helsinki and was approved by the ethics committee of the Beijing Tongren Hospital, Capital Medical University. All subjects gave their informed consent after the aim and the possible risks of the study had been explained. Inclusion criteria for the diagnosis of active ISCNV were subretinal and intraretinal hemorrhages as shown on ophthalmoscopy and on fundus photographs, and macular edema due to subretinal, or additionally intraretinal, leakage as demonstrated by fluorescein angiography. OCT demonstrated intraretinal edema, subretinal fluid and pigment epithelial detachment [15]. Due to the acute stage of the disease, the duration of symptoms was usually
Ophthalmologica
Ophthalmologica 2014;231:221–225 DOI: 10.1159/000357114
Received: July 19, 2013 Accepted after revision: October 30, 2013 Published online: March 5, 2014
Choroidal Thickness in Idiopathic Subfoveal Choroidal Neovascularization Xu-Sheng Cao a Xiao-Yan Peng b Qi-Sheng You b Yong-Peng Zhang a Jost B. Jonas b, c a Department of Ophthalmology and b Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China; c Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University, Heidelberg, Germany
Key Words Choroidal thickness · Enhanced depth imaging · Optical coherence tomography · Choroidal neovascularization
Abstract Purpose: To evaluate choroidal thickness in patients with idiopathic choroidal neovascularization. Methods: The observational case series study included patients who were consecutively diagnosed with idiopathic unilateral choroidal neovascularization as demonstrated by ophthalmoscopy, fluorescein angiography and enhanced depth imaging optical coherence tomography (EDI-OCT). Using EDI-OCT, choroidal thickness was measured at the fovea and at locations in a distance of 500, 1,000 and 1,500 μm temporal and nasal to the fovea. Results: Mean subfoveal choroidal thickness was significantly (p = 0.002) thicker in the study group than in the control group (357 ± 99 vs. 316 ± 83 μm). In a parallel manner, the differences between the study group and the control group in choroidal thickness were significant for all other measurement points, except for the examination at 1,500 μm nasal to the fovea (p = 0.09). The results remained unchanged after adjusting for axial length and age. Conclusions: Idiopathic unilateral choroidal neovascularization is associated with a thickening of the choroid. © 2014 S. Karger AG, Basel
© 2014 S. Karger AG, Basel 0030–3755/14/2314–0221$39.50/0 E-Mail [email protected] www.karger.com/oph
Introduction
Idiopathic subfoveal choroidal neovascularization (ISCNV) is defined as subfoveal choroidal neovascularization occurring in patients younger than 50 years who do not have evidence of any macular or retinal disease potentially associated with subfoveal choroidal neovascularization. These diseases include age-related macular degeneration, myopic retinopathy, presumed histoplasmosis syndrome, angioid streaks and inflammatory, traumatic or hereditary disorders [1]. Although ISCNV has a relatively favorable prognosis compared to subfoveal choroidal neovascularization in diseases such as exudative age-related macular degeneration or polypoidal choroidal vasculopathy, severe visual loss can occur at a relatively young age [2, 3]. While the pathomechanism of subfoveal choroidal neovascularization in other disorders has been intensively explored, few studies have focused on the mechanism of ISCNV [4–6]. The choroid receives approximately 95% of all ocular blood flow and is primarily or secondarily involved in the pathogenesis of many diseases of the posterior segment of the eye [7–10]. The choroidal thickness can be measured by the technique of enhanced depth imaging by spectral domain optical coherence tomography (EDI-OCT) which was recently described by Spaide et al. [11] and Margolis and Spaide [12]. Previous studies have reported that some diseases, such Prof. X.-Y. Peng Beijing Institute of Ophthalmology 17 Hougou Lane, Chongnei Street Beijing 100005 (China) E-Mail drpengxy @ 163.com
Fig. 1. Cross-sectional imaging of the cho-
roid using EDI-OCT. Choroidal thickness was measured at 500, 1,000 and 1,500 μm temporal and nasal to the fovea.
as central serous choroidoretinopathy and polypoidal choroidal vasculopathy, are associated with an abnormally thick choroid while other disorders such as myopic retinopathy have an abnormally thin choroid [7–10, 13, 14]. Since an abnormal thickness of the choroid may allow conclusions on the pathogenesis and may be helpful for the diagnosis of ISCNV, we designed this study to assess choroidal thickness in active ISCNV.
Methods This prospective clinical observational study included patients in whom an active idiopathic unilateral choroidal neovascularization was consecutively diagnosed in the Beijing Tongren Hospital between August and December 2012. The contralateral unaffected eyes served as control group. The study followed the tenets of the Declaration of Helsinki and was approved by the ethics committee of the Beijing Tongren Hospital, Capital Medical University. All subjects gave their informed consent after the aim and the possible risks of the study had been explained. Inclusion criteria for the diagnosis of active ISCNV were subretinal and intraretinal hemorrhages as shown on ophthalmoscopy and on fundus photographs, and macular edema due to subretinal, or additionally intraretinal, leakage as demonstrated by fluorescein angiography. OCT demonstrated intraretinal edema, subretinal fluid and pigment epithelial detachment [15]. Due to the acute stage of the disease, the duration of symptoms was usually
