Evaluation of changes in choroidal thickness and the choroidal vascularity index after hemodialysis in patients with end-stage renal disease by using swept-source optical coherence tomography

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Abstract

To evaluate the effect of hemodialysis on choroidal thickness and the choroidal vascularity index (CVI) in patients with end-stage renal disease (ESRD) by using swept-source optical coherence tomography.

Thirty-two eyes of 32 patients with ESRD undergoing hemodialysis were recruited prospectively. Detailed ophthalmologic examinations and swept-source optical coherence tomography were performed immediately before and after hemodialysis. Choroidal thickness maps were generated automatically by using built-in software. The CVI was calculated using binarized choroidal optical coherence tomography images. Systemic parameters such as body weight and blood pressure were also measured. The changes in systemic and ocular parameters during hemodialysis were evaluated. Subjects were divided into 2 groups (diabetes mellitus [DM] vs non-diabetes mellitus) for subgroup analysis.

Total choroidal thickness showed a significant overall decrease after hemodialysis (−10.9 ± 14.0, P <.001). In the subgroup analysis, total choroidal thickness significantly decreased in both patients with DM (−11.3 ± 13.6, P = .004) and those without (−10.6 ± 14.9, P = .020), but the reduction of choroidal thickness was observed in more subfields in patients with DM than in those without. The CVI did not significantly change after hemodialysis ( P = .717). No significant systemic and ocular factors affected the changes in total choroidal thicknesses.

Choroidal thickness significantly decreased after hemodialysis in most subfields regardless of the presence of DM. Peri-hemodialysis choroidal changes could be considered in the management of patients with ESRD. Swept-source optical coherence tomography can provide ample and reliable quantitative data for monitoring ocular hemodynamic changes.

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Choroidal vascularity index as a measure of vascular status of the choroid: Measurements in healthy eyes from a population-based study

Rupesh Agrawal, Preeti Gupta, Kara-Anne Tan … (2016)

The vascularity of the choroid has been implicated in the pathogenesis of various eye diseases. To date, no established quantifiable parameters to estimate vascular status of the choroid exists. Choroidal vascularity index (CVI) may potentially be used to assess vascular status of the choroid. We aimed to establish normative database for CVI and identify factors associated with CVI in healthy eyes. In this population-based study on 345 healthy eyes, choroidal enhanced depth imaging optical coherence tomography scans were segmented by modified image binarization technique. Total subfoveal choroidal area (TCA) was segmented into luminal (LA) and stromal (SA) area. CVI was calculated as the proportion of LA to TCA. Linear regression was used to identify ocular and systemic factors associated with CVI and subfoveal choroidal thickness (SFCT). Subfoveal CVI ranged from 60.07 to 71.27% with a mean value of 65.61 ± 2.33%. CVI was less variable than SFCT (coefficient of variation for CVI was 3.55 vs 40.30 for SFCT). Higher CVI was associated with thicker SFCT, but not associated with most physiological variables. CVI was elucidated as a significant determinant of SFCT. While SFCT was affected by many factors, CVI remained unaffected suggesting CVI to be a more robust marker of choroidal diseases.

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Direct comparison of spectral-domain and swept-source OCT in the measurement of choroidal thickness in normal eyes.

Ledys Copete, Rubén Moreno, Ignacio Flores … (2014)

To compare spectral-domain optic coherence tomography (SD-OCT) and swept-source OCT (SS-OCT) in the study of choroidal thickness (CT) in healthy eyes. Prospective, cross-sectional, single-centre study. 82 healthy eyes of 46 patients were included. In a single session, Topcon 3D-2000 SD-OCT and 1050 nm SS-OCT prototype devices were used to perform OCT scans using a single line protocol. Two masked investigators independently, manually determined 13 CT measurements consisting of one subfoveal (SFCT), and six measurements on either side of the fovea (nasal and temporal) taken every 500 microns apart. The mean CT (MCT) was the mean average of these 13 measurements. SD-OCT was able to reproducibly measure the CT in 74.4% of eyes vs 100% with SS-OCT (p<0.05; Fisher's Exact test). In those eyes measured by both systems, mean SFCT was 279.4 ± 96.9 μm (range, 84-506) with SD-OCT vs 285.7 ± 88.9 μm (range 130-527) with SS-OCT (p=0.11; Student's t test paired data). Mean MCT was 243.8 ± 78.8 μm (range 103.6-433.2) with SD-OCT vs 242.2 ± 81.8 μm (range 97.6-459) with SS-OCT (p=0.64; Student's t test paired data). The difference in SFCT and MCT was not statistically significant between both devices. Intraclass correlation coefficient was higher than 0.9 interobserver and interdevice measurements. SFCT Bland-Altman plots showed 95% interobserver measurement agreement within ±34 for SD-OCT, ±22 for SS-OCT and ±60 μm intersystems. SS-OCT permitted accurate identification of the choroido-scleral border in 100% of normal eyes, suggesting that SS-OCT was the superior modality for the measurement of CT.

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Diabetic choroidopathy. Light and electron microscopic observations of seven cases.

Alex Fine, Ahmed A Hidayat (1985)

The choroid of seven young patients (ages 20-29 years), who had had diabetes mellitus for many years (14-23 years) was studied by light and electron microscopy. The eight enucleated eyes were blind and painful as a complication of diabetes mellitus. Histopathologically, the choriocapillaris and other small choroidal blood vessels disclosed marked basement membrane thickening of their walls. Periodic acid-Schiff-positive homogeneous acellular nodules were present and resembled those of diabetic glomerulosclerosis (Kimmelsteil-Wilson disease). Some choroidal arteries were arteriosclerotic. Choroidal compromise was suggested by luminal narrowing of the capillaries, capillary dropout, and focal scarring. Choroidal neovascularization with subretinal fibrovascular membranes occurred in two patients at the midperiphery and periphery, and resembled those of retinitis proliferans. Leakage of proteinaceous fluid into the choroidal stroma and beneath the focally detached pigment epithelium was suggested by the electron microscopic observations. Choroidal vasculopathy in diabetes mellitus is similar to much of what has been described in other tissues of the eye and body, and suggests an important role in the pathogenesis of diabetic retinopathy since the outer retinal layers are largely dependent on the choroid for their nutrition and oxygenation.

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Author and article information

Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MEDI

Title: Medicine

Publisher: Wolters Kluwer Health

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: May 2019

Publication date (Electronic): 03 May 2019

Volume: 98

Issue: 18

Electronic Location Identifier: e15421

Affiliations

[a ]Department of Ophthalmology

[b ]Division of Nephrology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.

Author notes

[∗ ]Correspondence: Heeyoon Cho, Department of Ophthalmology, Hanyang University College of Medicine, #222, Wangimni-ro, Seongdong-gu, Seoul 04763, Korea (e-mail: hycho@ 123456hanyang.ac.kr ); Joo-Hark Yi, Division of Nephrology, Department of Internal Medicine, Hanyang University College of Medicine, #222, Wangimni-ro, Seongdong-gu, Seoul 04763, Korea (e-mail: joohark@ 123456hanyang.ac.kr ).

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Publisher ID: MD-D-18-04167 Accession ID: 15421

DOI: 10.1097/MD.0000000000015421

PMC ID: 6504263

PubMed ID: 31045801

SO-VID: 5d437a0d-46ff-45ac-8146-c4c16b99c368

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This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

History

Date received : 12 June 2018

Date revision received : 6 December 2018

Date accepted : 4 April 2019

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Keywords: choroidal thickness,choroidal vascular index,hemodialysis,swept-source optical coherence tomography

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Keywords: choroidal thickness, choroidal vascular index, hemodialysis, swept-source optical coherence tomography

Evaluation of changes in choroidal thickness and the choroidal vascularity index after hemodialysis in patients with end-stage renal disease by using swept-source optical coherence tomography

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Most cited references 22

Choroidal vascularity index as a measure of vascular status of the choroid: Measurements in healthy eyes from a population-based study

Direct comparison of spectral-domain and swept-source OCT in the measurement of choroidal thickness in normal eyes.

Diabetic choroidopathy. Light and electron microscopic observations of seven cases.

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