Detection of pachychoroid neovasculopathy with optical coherence tomography angiography versus dye angiography imaging

• Published in: Photodiagnosis and photodynamic therapy Vol. 40; p. 103126
• Main Authors: Su, Yongyue, Zhang, Xiongze, Gan, Yuhong, Zeng, Yunkao, Wen, Feng
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.12.2022
• Subjects: Central Serous Chorioretinopathy - diagnostic imaging; Choroid - blood supply; Choroid - diagnostic imaging; Choroidal neovascularization; Choroidal Neovascularization - diagnostic imaging; Choroidal Neovascularization - drug therapy; Fluorescein Angiography - methods; Fundus fluorescein angiography; Humans; Indocyanine green angiography; Optical coherence tomography angiography; Pachychoroid neovasculopathy; Photochemotherapy - methods; Retrospective Studies; Tomography, Optical Coherence - methods; Indocyanine green angiography; Pachychoroid neovasculopathy; Fundus fluorescein angiography; Optical coherence tomography angiography; Choroidal neovascularization
• ISSN: 1572-1000; 1873-1597
• DOI: 10.1016/j.pdpdt.2022.103126

•OCTA showed superior sensitivity and specificity for identifying PNV.•PNV not identified by FFA and ICGA likely manifests as overall small capillaries.•PNV characterized by a late wash-out on ICGA is challenging to detect by ICGA.•OCTA can be an effective and noninvasive method for monitoring PNV. To investigate the sensitivity and specificity of optical coherence tomography angiography (OCTA) versus dye angiography for detecting pachychoroid neovasculopathy (PNV) and to determine the morphological factors that affect PNV detection. Patients with pachychoroid phenotype were prospectively enrolled and underwent multimodal imaging examinations during the same visit. The diagnostic accuracy of fundus fluorescein angiography (FFA), FFA combined with indocyanine green angiography (ICGA) and OCTA for PNV was evaluated using multimodal imaging as the reference. Multimodal parameters of PNV were qualitatively and quantitatively assessed. PNV was detected in 58 eyes (46 patients) out of 340 pachychoroid eyes (201 patients) according to reference standard. Patients with PNV eyes were significantly older (54.6±7.56 vs. 48.2±9.1 years), were more likely to have a chronic central serous chorioretinopathy history (CSC) (93.1% vs. 12.4%) and had a worse visual acuity (0.30±0.22 vs. 0.58±0.30) than those without PNV eyes (all P<0.001). The sensitivity of FFA, FFA combined with ICGA, and OCTA in detecting PNV in patients with the pachychoroid phenotype was 67.2%, 63.8% and 98.3%, respectively, and the specificity was 87.2%, 96.8% and 100.0%, respectively. PNV not identified by dye angiography was more manifested as the absence of late plaque hypercyanescence on ICGA (P<0.001) and overall smaller capillaries without a distinct pattern (P=0.001), fewer core vessels (P=0.002) and smaller area (P=0.044). OCTA showed superior detection rate and accuracy for identifying PNV over dye angiography. In case multimodal imaging is unavailable, OCTA can be an effective and noninvasive method for monitoring PNV and guiding treatment decisions.