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      Choroidal Vascularity Index in Vogt-Koyanagi-Harada Disease: An EDI-OCT Derived Tool for Monitoring Disease Progression


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          We assessed the application of the choroidal vascularity index (CVI) in the follow-up of Vogt-Koyanagi-Harada disease (VKH) patients derived from image binarization of enhanced depth imaging optical coherence tomography (EDI-OCT) images with Fiji software. Our secondary objective was to derive the retinochoroidal vascularity index based on en face fundus fluorescein and indocyanine green angiography (FFA and ICGA).


          In this retrospective cohort study, EDI-OCT scans of 18 eyes of 9 patients with VKH were obtained at baseline within 2 weeks of acute presentation, and again at 6 to 12 months. Images with poor quality were excluded. Choroidal thickness (CT) and CVI were analyzed and compared to 13 eyes of 13 healthy controls. En face FFA and ICGA obtained from 12 eyes of 7 patients were segmented to derive retinochoroidal vascularity index.


          There was no statistical difference in age or sex between the study group and controls. Choroidal thickness of patients with VKH was 359.23 ± 57.63 μm at baseline, compared to 274.09 ± 56.98 μm in controls ( P = 0.003). Follow-up CT in VKH patients was 282.62 ± 42.51 μm, which was significantly decreased from baseline ( P = 0.0001). Choroidal vascularity index in VKH patients was 70.03 ± 1.93% at baseline, compared to 64.63 ± 1.92% in controls ( P < 0.001). Choroidal vascularity index was 66.94 ± 1.82% at follow-up, significantly reduced from baseline ( P < 0.0001). Fundus fluorescein angiography and ICGA retinochoroidal vascularity indices at baseline were 70.67 ± 2.65% and 66.42 ± 2.16%, respectively.


          In this small series of VKH patients, EDI-OCT–derived CVI had a statistically significant reduction over time, similar to CT. We propose that OCT, FFA, and ICGA-derived vascularity indices may be potential novel supportive tools in monitoring disease progression in VKH.

          Translational Relevance

          Choroidal vascularity index can be used potentially to study and analyze the structural changes in choroid. It can be a useful tool to explain the changes in the CT in different retinochoroidal disorders. Choroidal vascularity index also can be used for longitudinal follow-up in patients with VKH disease and other inflammatory disease involving the choroid.

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          Most cited references28

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          Proposed lexicon for anatomic landmarks in normal posterior segment spectral-domain optical coherence tomography: the IN•OCT consensus.

          To develop a consensus nomenclature for the classification of retinal and choroidal layers and bands visible on spectral-domain optical coherence tomography (SD-OCT) images of a normal eye.
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            To determine changes in choroidal structure by binarization of optical coherence tomographic (OCT) images.
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              Analysis of choroidal morphologic features and vasculature in healthy eyes using spectral-domain optical coherence tomography.

              To analyze the morphologic features and vasculature of the choroid in healthy eyes using spectral-domain (SD) optical coherence tomography (OCT). Cross-sectional retrospective review. Forty-two healthy subjects (42 eyes) with no ocular disease who underwent high-definition scanning with Cirrus high-definition OCT (Carl Zeiss Meditec, Inc., Dublin, CA) at the New England Eye Center, Boston, Massachusetts, between November 2009 and September 2010. The SD OCT images were evaluated for morphologic features of the choroid, including the shape of the choroid-scleral border, location of the thickest point of choroid, and regions of focal choroidal thinning. Total choroidal thickness and large choroidal vessel layer thickness were measured by 2 independent observers experienced in analyzing OCT images using the Cirrus linear measurement tool at the fovea, 750 μm nasal and temporal to the fovea. Custom software was used to calculate the ratio of choroidal stroma to the choroidal vessel lumen. Qualitative assessment of the choroidal morphologic features, quantitative analysis of choroidal vasculature, and use of novel automated software to determine the ratio of choroidal stromal area to the area of choroidal vessel lumen. The 42 subjects had a mean age of 51.6 years. All subjects (100%) had a so-called bowl or convex shape to the choroid-sclera junction, and the thickest point of the choroid was under the fovea in 88.0% of the subjects. The mean choroidal thickness was 256.8 ± 75.8 μm, mean thickness of the large choroidal vessel layer was 204.3 ± 65.9 μm, and that of the medium choroidal vessel layer-choriocapillaris layer was 52.9 ± 20.6 μm beneath the fovea. The ratio of large choroidal vessel layer thickness to the total choroidal thickness beneath the fovea was 0.7 ± 0.06. The software-generated ratio of choroidal stromal area to the choroidal vessel lumen area was 0.27 ± 0.08, suggesting that choroidal vessel lumen forms a greater proportion of the choroid than the choroidal stroma in healthy eyes. This is the first study to describe the morphologic features and vasculature of the choroid in healthy eyes from 1-line raster scans obtained using SD OCT. The method described holds promise and has immediate clinical usefulness in recognizing subtle changes in choroidal morphologic features and the role of choroidal angiopathy in various disease states that, in the future, may inform new treatment methods. Proprietary or commercial disclosure may be found after the references. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

                Author and article information

                Transl Vis Sci Technol
                Transl Vis Sci Technol
                Translational Vision Science & Technology
                The Association for Research in Vision and Ophthalmology
                25 July 2016
                July 2016
                : 5
                : 4
                : 7
                [1 ]National Healthcare Group Eye Institute Tan Tock Seng Hospital, Singapore
                [2 ]Narayana Nethralaya, Bangalore, India
                Author notes
                Correspondence: Rupesh Agrawal, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore 308433. e-mail: rupesh_agrawal@ 123456ttsh.com.sg
                Padmamalini Mahendradas, Narayana Nethralaya, Bangalore, Karnataka, India. e-mail: m.padmamalini@ 123456gmail.com

                RA and LKHL are joint first authors.

                tvst-05-04-05 TVST-16-0335

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                : 27 January 2016
                : 26 April 2016

                optical coherence tomography,image analysis,choroid,vogt-koyanagi-harada disease


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