Small dome-shaped pigment epithelium detachment in polypoidal choroidal vasculopathy: an under-recognized sign of polypoidal lesions on optical coherence tomography?

• Published in: Eye (London) Vol. 36; no. 4; pp. 733 - 741
• Main Authors: Wang, Yuwei, Bo, Qiyu, Jia, Huixun, Sun, Mengsha, Yu, Yang, Huang, Peirong, Wang, Jing, Xu, Nana, Wang, Fenghua, Wang, Hong, Sun, Xiaodong
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 01.04.2022; Nature Publishing Group UK
• Subjects: Age; Angiography; Choroid - pathology; Choroidal Neovascularization - diagnosis; Choroidal Neovascularization - pathology; Coloring Agents; Epithelium; Epithelium - pathology; Fluorescein Angiography - methods; Humans; Indocyanine Green; Lesions; Macular degeneration; Medical imaging; Polyps - diagnosis; Retinal Detachment - diagnostic imaging; Retinal Detachment - pathology; Retrospective Studies; Tomography; Tomography, Optical Coherence - methods; Vascular diseases
• ISSN: 0950-222X; 1476-5454
• DOI: 10.1038/s41433-020-01390-0

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. 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. 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. 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.