Optical coherence tomography-based misdiagnosis and morphological distinction in pachychoroid neovasculopathy vs. polypoidal choroidal vasculopathy

PurposeTo evaluate the rate of misdiagnosis of aneurysmatic pachychoroid type 1 choroidal neovascularization/polypoidal choroidal vasculopathy (PAT1/PCV) among cases diagnosed as non-aneurysmatic pachychoroid neovasculopathy (PNV) and to define optical coherence tomography (OCT) features facilitating their distinction.MethodsThe database of the Department of Ophthalmology, Ludwig-Maximilians University Munich, was screened for patients diagnosed with PNV. Multimodal imaging was screened for the presence of choroidal neovascularization (CNV) and aneurysms/polyps. Imaging features facilitating the diagnosis of PAT1/PCV were analysed.ResultsIn total, 49 eyes of 44 patients with a clinical PNV diagnosis were included, of which 42 (85.7%) had PNV and 7 (14.3%) represented misdiagnosed PAT1/PCV. SFCT was comparable (PNV: 377 +/- 92 vs. PAT1/PCV: 400 +/- 83 mu m; p = 0.39). Whereas no difference was detected in total pigment epithelium detachment (PED) diameter (p = 0.46), maximum PED height was significantly higher in the PAT1/PCV group (199 +/- 31 vs. 82 +/- 46, p < 0.00001). In a receiver operating characteristic (ROC) analysis, the optimum cutoff for defining peaking PED was 158 mu m with an area under the curve of 0.969, a sensitivity of 1.0 (95% CI: 0.59-1.0), and a specificity of 0.95 (95% CI: 0.84-0.99). Sub-retinal hyperreflective material (SHRM; p = 0.04), sub-retinal ring-like structures (SRRLS; p < 0.00001), and sub-RPE fluid (p = 0.04) were significantly more frequent in eyes with PAT1/PCV.ConclusionA relevant percentage of eyes diagnosed with PNV might instead suffer from PAT1/PCV. The detection of a maximum PED height (peaking PED) exceeding approximately 150 mu m, SHRM, SRRLS, and sub-RPE fluid might greatly aid in the production of a more accurate diagnosis.

Automated summary

The study evaluated the misdiagnosis rate of non-aneurysmatic pachychoroid neovasculopathy (PNV) as aneurysmatic pachychoroid type 1 choroidal neovascularization/polypoidal choroidal vasculopathy (PAT1/PCV), and identified optical coherence tomography (OCT) features that help distinguish between the two conditions. It was found that a significant proportion of eyes diagnosed with PNV actually had PAT1/PCV, and measuring maximum pigment epithelium detachment (PED) height, sub-retinal hyperreflective material (SHRM), sub-retinal ring-like structures (SRRLS), and sub-RPE fluid can aid in the accurate diagnosis of PAT1/PCV.