Abstract
Purpose
To evaluate the diagnostic accuracy of spectral-domain optical coherence tomography (SD-OCT) and swept-source optical coherence tomographic angiography (SS-OCTA) to identify polypoidal lesions in serous or serosanguinous maculopathy.
Materials and methods
A retrospective review of patients presenting pigment epithelial detachments (PEDs) with the diagnosis of polypoidal choroidal vasculopathy (PCV), neovascular age-related macular degeneration (nAMD), and central serous chorioretinopathy (CSC), all of which underwent SD-OCT, SS-OCTA, and indocyanine green angiography (ICGA). Typical features of polypoidal lesions on SD-OCT included sharply peaked PED, notched PED, and hyperreflective ring underneath PED. SS-OCTA feature was vascularized PEDs on cross-sectional images corresponding to cluster-like structures on en face images. The parameters of PEDs were measured for analysis.
Results
Of 72 eyes, 30 had PCV, 22 had nAMD, and 20 had CSC. A total of 128 localized PEDs were detected on SD-OCT. Typical features on SD-OCT had a high specificity (94.0%) but a limited sensitivity (73.8%). SS-OCTA features provided a higher sensitivity (96.7%). PEDs of the polypoidal lesions unrecognized by SD-OCT were dome-shaped, with smaller ratio of height to base diameter and less area, and almost had heterogeneous internal reflectivity and a connected double-layer sign. Some lesions misidentified by SS-OCTA developed into ICGA-proven polypoidal lesions at follow-up visits.
Conclusion
A small dome-shaped PED with heterogeneous internal reflectivity and a connected double-layer sign on SD-OCT may suggest a polypoidal lesion of PCV. SS-OCTA may be a helpful tool to investigate preclinical PCV and observe the formation of polypoidal lesions.
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Funding
The study was supported by the National Major Scientific and Technological Special Project for “Significant New Drugs Development” during the Thirtieth Five-year Plan Period (2019ZX09301113); National Natural Science Foundation of China (81730026); National Key R&D Program (2017YFA0105301); Science and Technology Commission of Shanghai Municipality (CTCCR-2016B02, 17411953000, 19495800700); Shanghai Collaborative Innovation Center for Translational Medicine (TM201722); Leaders Training Program of Shanghai Municipality Commission of Health and Family Planning (2018BR10); and Bethune-Langmu eye research fund for the young and middle-aged ophthalmologist (BJ-LM2018001J).
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YW and QB had full access to all of the data and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: YW, QB, HJ, HW, and FW. Acquisition, analysis, or interpretation of data: YW, QB, HJ, MS, YY, JS, PH, JW, NX, HW, FW, and XS. Drafting of the manuscript: YW, QB, MS, JS, YY, PH, JW, and NX. Critical revision of the manuscript for important intellectual content: HW, FW, and XS. Statistical analysis: YW, QB, and HJ. Obtained funding: PH, FW, and XS.
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Wang, Y., Bo, Q., Jia, H. et al. Small dome-shaped pigment epithelium detachment in polypoidal choroidal vasculopathy: an under-recognized sign of polypoidal lesions on optical coherence tomography?. Eye 36, 733–741 (2022). https://doi.org/10.1038/s41433-020-01390-0
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DOI: https://doi.org/10.1038/s41433-020-01390-0
