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Orly Gal-Or, Kunal K Dansingani, Fatimah Gilani, K Bailey Freund; Swept-source optical coherence tomography identifies choroidal vascular and pigmentary changes resembling pachychoroid spectrum disorders around choroidal nevi. Invest. Ophthalmol. Vis. Sci. 2017;58(8):6003.
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© ARVO (1962-2015); The Authors (2016-present)
The pachychoroid spectrum includes central serous chorioretinopathy, pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, and polypoidal choroidal vasculopathy which are characterized by retinal pigment epithelium (RPE) alterations overlying pachyvessels. The mechanisms giving rise to a pachychoroid phenotype remain under investigation. Choroidal nevi are benign space-occupying tumors which compress adjacent tissues as they grow and induce reactive changes. The purpose of this study was to examine choroidal vasculature surrounding choroidal nevi for features which may inform disease mechanisms in the pachychoroid spectrum.
Patients with choroidal nevi were identified through retrospective review. All patients underwent spectral-domain and swept-source optical coherence tomography (SD-OCT and SS-OCT). The main outcome measures included visualization of distended Haller layer vessels, choriocapillaris attenuation, RPE abnormalities and other nevus characteristics observed with SS-OCT.
Fifteen eyes of 15 patients were included (mean age: 68 years; range 40-95). BCVA ranged from 20/20—20/60. Secondary complications included overlying subretinal fluid, shallow RPE detachments, type 1 neovascularization, and drusen. Inner choroidal attenuation was observed in all eyes and dilated Haller vessels surrounding the nevi were seen in 60% of eyes. En Face SS-OCT showed alterations in the morphology of the vasculature surrounding the nevi correlating with size, revealing dilated pachyvessels flanking the larger lesions and minor alterations in choroidal architecture surrounding smaller nevi.
Distended Haller vessels resembling those of the pachychoroid spectrum occur around choroidal nevi which are associated with RPE changes resembling those of the pachychoroid spectrum. These vascular changes may result from a mass effect compressing the inner choroid with resultant venous engorgement. Longitudinal study is needed to test this mechanistic hypothesis.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Melanotic choroidal nevi (A-D) showing a spectrum of secondary RPE abnormalities (A- shallow RPE detachment, B- normal, C -drusen, D- type 1 NV) with their corresponding structural B-scans and En-face swept source OCT flattened with respect to Bruch’s membrane and segmented to the plane of the Haller vessels. Asterisks indicate bordering pachyvessels.
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