Recent improvements in ophthalmic imaging have led to the identification of a thickened choroid or pachychoroid to be associated with a number of retinal diseases. The number of conditions linked to this phenotype has continued to widen with specific endophenotypes found within the pachychoroid spectrum. The spectrum includes choroidal features such as focal or diffuse choroidal thickening and thinning of the overlying inner choroid, and choroidal hyperpermeability as demonstrated by indocyanine green angiography. In addition, these diseases are associated with overlying retinal pigmentary changes and retinal pigment epithelial dysfunction and may also be associated with choroidal neovascularization. This article provides a comprehensive review of the literature looking at diseases currently described within the pachychoroid spectrum including central serous chorioretinopathy, pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy/aneurysmal type 1 neovascularization, peripapillary pachychoroid disease and focal choroidal excavation. We particularly focus on clinical imaging, genetics and pathological findings in these conditions with the aim of updating evidence suggesting a common aetiology between diseases within the pachychoroid spectrum.

Pachychoroid spectrum disease.

Purpose To describe the prevalence and clinical characteristics of focal choroidal excavation (FCE) in patients with exudative maculopathy due to age-related macular degeneration with choroidal neovascularisation (AMD-CNV), polypoidal choroidal vasculopathy (PCV) and central serous chorioretinopathy (CSC). Methods Three hundred and forty-three patients (343 presenting eyes and 255 fellow unaffected eyes) from consecutive patients presenting with untreated AMD-CNV, PCV or CSC are prospectively recruited. Two independent retinal specialists masked to the clinical diagnosis graded the presence of FCE by examining the findings from spectral-domain optical coherence tomography (SD-OCT). The frequency and clinical characteristics of FCE in each of the three clinical diagnosis groups were compared. Results The diagnosis in the presenting eye was AMD-CNV in 92 patients, PCV in 149 patients, retinal angiomatous proliferation (RAP) in 3 patients and CSC in 99 patients; 255 fellow eyes free of clinical diseases were also graded. The prevalence of FCE was 2.3% (total 14 eyes; 10 presenting eyes, 4 fellow eyes) out of 598 eyes examined. In presenting eyes, FCE was most prevalent in PCV (6.0%), followed by AMD-CNV (1.0%) and CSC (0%), p=0.02. In fellow eyes, the prevalence of FCE was 2.9%, 0% and 1.2% in patients with PCV, AMD-CNV and CSC, respectively. Eyes with FCE had a significantly longer axial length (24.93±1.65 mm vs 23.49±1.10 mm, p Conclusions FCE is more common in PCV than AMD-CNV and CSC. Disturbance in the choroid/retinal pigment epithelium/Bruch membrane interface affected by FCE may be linked to the pathogenesis of PCV and AMD-CNV.

https://bjo.bmj.com/content/bjophthalmol/100/7/918.full.pdf

Prevalence and clinical correlates of focal choroidal excavation in eyes with age-related macular degeneration, polypoidal choroidal vasculopathy and central serous chorioretinopathy

PURPOSE To study the prevalence, tomographic features, and clinical characteristics of focal choroidal excavation (FCE) in eyes with exudative age-related macular degeneration (AMD). METHODS We examined 243 consecutive eyes with exudative AMD with a prototype swept-source optical coherence tomography (OCT) system. Three-dimensional images of the macular area, covering 6 × 6 mm(2), were reconstructed by segmentation of the outer surface of the retinal pigment epithelium. RESULTS Three-dimensional swept-source OCT revealed 15 excavations in 12 eyes (4.9%); 10 had a single excavation and 2 had multiple excavations (2 and 3 excavations, respectively). In multiaveraged scans, unusual choroidal tissue was found beneath 5 excavations, bridging the excavation with the outer choroidal boundary. Additionally, the suprachoroidal space was observed beneath 7 excavations-the outer choroidal boundary appeared to be pulled inward by this bridging tissue. In 9 excavations, color fundus photographs showed pigmentary disturbance. Fourteen excavations (93.3%) were located within or adjacent to the choroidal neovascularization area. Compared with eyes without FCE, in eyes with FCE, the mean age was significantly higher (P = 0.040) and mean visual acuity was significantly better (P = 0.014). In addition, polypoidal lesions were observed in 8 of 12 eyes with FCE, but they appeared to have a limited effect on either the rate of FCE (P = 0.44) or the clinical characteristics of the eyes. CONCLUSIONS While FCE may be partially related to the choroidal neovascularization associated with exudative AMD, other factors may also influence this association.

Association of focal choroidal excavation with age-related macular degeneration.

Focal choroidal excavation (FCE) is defined as an area of concavity in choroid detected on optical coherence tomography. These are mostly present in macular region without evidence of accompanying scleral ectasia or posterior staphyloma. Though initially considered to be congenital, increasing number of cases have been identified in association with other choroidal pathologies such as central serous choroidopathy, choroidal neovascularisation, polypoidal choroidal vasculopathy, choroiditis, choroidal tumours. In this review article, we aim to elaborate on the morphology, pathogenesis and differential diagnosis of FCE and specifically discuss the spectrum of diseases with known association along with the impact of their treatment on FCE.

https://bjo.bmj.com/content/bjophthalmol/105/8/1043.full.pdf

Focal choroidal excavation: review of literature.

To evaluate the prevalence and clinical features of focal choroidal excavation (FCE) in patients presenting with central serous chorioretinopathy (CSC). This is a retrospective consecutive case series of consecutive patients with CSC who were referred for spectral domain optical coherence tomography (SD-OCT) between January 2010 and December 2011. Medical records were reviewed and clinical features including presence of FCE in SD-OCT, fluorescence angiography (FA), and indocyanine green angiography (ICGA) were studied. Among the 116 CSC patients assessed, FCE was found in 11 eyes of 7 (6.0%) patients. FCE was associated with subretinal fluid in six eyes of six patients and serous pigment epithelial detachment in three eyes of two patients. The mean central subfield retinal thickness of CSC eyes with FCE was 283.7 μm, compared with 377.5 μm for CSC eyes without FCE (Mann–Whitney U-test, P=0.020). Five FCE eyes of five patients had focal leakage on FA. Choroidal hyperpermeability on ICGA was found in seven CSC eyes with FCE, with four eyes showing hypofluorescent spot corresponding to the FCE. After a mean follow-up of 16 months, visual acuity of all 11 eyes with FCE remained stable or improved at the last follow-up. FCE is not an uncommon feature in patients with CSC and might be associated with choroidal hemodynamic disturbances.

/pdf/focal-choroidal-excavation-in-patients-with-central-serous-3hv6w9qp6c.pdf

Focal choroidal excavation in patients with central serous chorioretinopathy

Focal choroidal excavation complicated by choroidal neovascularization.

An injectable hydrogel based on hyaluronic acid prepared by Schiff base for long-term controlled drug release.

The repair of large-diameter corneal stroma defects is a major clinical problem. Although some studies have attempted to use hydrogels to repair corneal damage, most of these hydrogels can only be used for focal stromal defects that are ≤ 3.5 mm in diameter due to poor hydrogel adhesion. Here, we investigated a photocurable adhesive hydrogel that mimics the extracellular matrix (ECM) with regard to composition for repairing 6-mm-diameter corneal stromal defects in rabbits. This ECM-like adhesive could be rapidly cured after light exposure, with high light transmittance and good mechanical properties. More importantly, this hydrogel maintained the viability and adhesion of cornea-derived cells and promoted their migration in vitro in 2D and 3D culture environments. Proteomics analysis confirmed that the hydrogel promoted cell proliferation and ECM synthesis. Furthermore, in rabbit corneal stromal defect repair experiments, it was proven by histological and proteomic analysis that this hydrogel could effectively promote corneal stroma repair, reduce scar formation and increase corneal stromal-neural regeneration at the 6-month follow-up. This work demonstrates the great application of ECM-like adhesive hydrogels for the regeneration of large-diameter corneal defects. This article is protected by copyright. All rights reserved.

ECM-like adhesive hydrogel for the regeneration of large corneal stromal defects.

Purpose: To investigate the long-term efficacy of intravitreal conbercept injection in treating idiopathic choroidal neovascularization (CNV). Methods: In this longitudinal retrospective cohort stu...

Long-Term Efficacy of Intravitreal Conbercept Injection in the Treatment of Idiopathic Choroidal Neovascularization

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Focal choroidal excavation complicated by choroidal neovascularization.

An injectable hydrogel based on hyaluronic acid prepared by Schiff base for long-term controlled drug release.

ECM-like adhesive hydrogel for the regeneration of large corneal stromal defects.

Long-Term Efficacy of Intravitreal Conbercept Injection in the Treatment of Idiopathic Choroidal Neovascularization