Significance Of Multi-mode Dection On Clinical Classification Of Polypoidal Choroidal Vasculopathy

Objective: To investigate the significance of multi-mode detection on the clinical classification of polypoidal choroidal vasculopathy(PCV),and to summarize and analyze the characteristics of PCV in different detection modes.Methods:30 eyes of 30 patients with PCV diagnosed in the our hospital during the period from January 2018 to December 2018 were selected.All of them underwent optical coherence tomography(OCT),fundus fluorescein angiography(FFA)and indocyanine green angiography(ICGA)and OCT angiography(Angio-OCT).The detection results of OCT,FFA+ICGA and Angio-OCT were analyzed and PCV was classified.The characteristics of PCV in different detection modes were analyzed.Results:1.According to the ICGA results,these PCV patients were divided into three groups:12 eyes of 12 cases in polypoidal dilatation type group,10 eyes of 10 cases in classic type group and 8 eyes of 8 cases in branching vascular network(BVN)group respectively.2.There were no significant differences in general data such as gender,age,body mass index(BMI),visual acuity,time from onset to visit and comorbidities among the three groups(P>0.05).There was no significant difference in the site classification among the three groups(P>0.05).The proportion of patients with pigment epithelial detachment(PED)and neuroepithelial detachment in classic type group and BVN type group were significantly higher than that in polypoidal dilatation type group(P<0.05),while the proportion of patients without vasa vasorum and with lesion leakage of static type were significantly lower than that in polypoidal dilatation type group(P<0.05).The proportion of patients with fibrosis membrane formation in BVN type group were significantly higher than that in classical type group and polypoidal dilatation type group(P<0.05).4.Main features of OCT images: In the classic type group,there were 6 eyes of 6 cases with neuroepithelial detachment: retinal pigment epithelium and entochoroidea showed high reflection signal,there was a steep dome shape and bulging in the direction of the retinal neuroepithelial layer,and its inner surface was irregular with nodules-like changes.In the BVN type group,there were 7 eyes of 7 cases with retinal PED: the detachment of retinal pigment epithelium and Bruch's membrane were separated,resulting in "double-decker sign".In the polypoidal dilatation type group,there were 2 eyes of 2 cases with neuroepithelial detachment:there was hunching of steep dome shape in pigment epithelium,the lateral nerve epithelium was detached.5.Main features of FFA+ICGA image: Polypoidal dilatation type: There were polypoidal dilatation lesions in the choroidal end of macular area.Classic type: There were abnormal branches corresponding choroidal vasoganglion in the macular area,and polypoidal dilatation lesions in ending part.BVN type: There was large abnormal vasoganglion in the macular area.There were 15 eyes of 15 cases with retinal PED in FFA: 3 eyes of 3 cases with serous PED,4 eyes 4 cases with hemorrhagic PED and 8 eyes of 8 cases with both serous and hemorrhagic PED.6.Main features of Angio-OCT images: BVN type: There were very similar BVN performances with ICGA in morphology,location and range.There was 1 eye with many highly bright spots under PED.But there was no such performance in ICGA.There was 1 eye with BVN next to PED.Polypoidal dilatation type: All showed high bright spots.There was 1 eye with highly bright spots under PED.But the position was slightly uncorrelated.There was 1 eye with highly bright spots not only in poly lesions,but also under PED.But there was no such performance in ICGA.The remaining patients could observe highly bright spots and BVN in the corresponding sites.Classic type: There were highly bright spots in the corresponding sites.Conclusions: PCV has its own distinctive features on OCT,FFA+ ICGA and Angio-OCT detection images.According to FFA+ICGA detection,PCV can be roughly divided into polypoidal dilatation type,classic type and BVN type.OCT may accurately distinguish neuroepithelial detachment in classical type and polypoid dilatation type.The retinal PED in BVN type is mainly characterized by double-decker sign.Angio-OCT may compensate the deficiency of OCT and FFA+ICGA to some extent,but can not completely replace them.It may more clearly present PED performances in BVN type.The application of multi-mode detection with OCT,FFA+ICGA and Angio-OCT may provide more important information on the diagnosis and treatment of PCV patients,and has certain significance for the clinical classification of PCV.