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Imaging and Diagnosis of Polypoidal Choroidal Vasculopathy

Introduction Polypoidal choroidal vasculopathy (PCV) was first described as a type of macular disorder presenting with recurrent subretinal pigment epithelial hemorrhage by Yannuzzi et al . in 1982. Similar cases have then been described by Kleiner and Stern. Initial findings from these patients all displayed two main features, including dilated and branching inner choroidal vessels, together with terminal reddish-orange, spheroid aneurysmal-like polyps, which can be found…

Choroidal Tumors

The differential diagnosis of intraocular tumors affecting the choroid can be particularly challenging due to the wide variety of such tumors. Choroidal tumors are both rare and highly diverse, and for this reason, diagnosis can be quite complex, which is why diagnosis of such tumors is typically limited to highly-specialized centers. Classically, numerous diagnostic techniques have been used, including indirect ophthalmoscopy, intravenous fluorescein angiography (FA), indocyanine-green…

The Choroid in Retinal Vascular Diseases

Choroidal and Retinal Vasculature—Why Should We Evaluate the Choroid in Retinal Vascular Diseases? The retina has two sources of oxygenation. The inner retina is supplied with oxygen by the retinal vasculature, whereas the outer retina, especially the photoreceptor layers, is supplied by the choroidal vasculature. Therefore, a structurally and functionally normal choroid, in addition to normal retinal vessels, is essential for proper retinal function. Retinal vasculature…

Choroidal Findings in Systemic Disorders

Introduction The choroid is a highly vascular tissue, per unit weight, the choroid is the tissue with the highest blood flow in the body. The choroid is an integral part of the nutrient and oxygen exchange with the outer third of the retina, retinal pigment epithelium, a portion of the optic nerve, and it acts as the sole source of metabolic exchange for the fovea. Choroidal…

Infectious Chorioretinal Diseases

Introduction Severe visual loss may occur among patients with infectious posterior uveitis and chorioretinitis, especially if there is a delay in the diagnosis. A number of infectious agents can affect the retinochoroidal tissue resulting in intraocular inflammation. These include a host of bacteria, viruses, fungi, and parasites. Often, infectious chorioretinitis may mimic noninfectious inflammatory conditions leading to difficulties in diagnosis. Initiation of therapy with corticosteroids in…

Chorioretinal Inflammatory Non-Infectious Diseases

Introduction Uveitis includes a complex group of inflammatory eye diseases. Anatomically, there are four main groups of uveitis: anterior uveitis, which affects anterior segment of the eye; intermediate uveitis, which primarily involves the vitreous and peripheral retina; posterior uveitis, which involves the posterior segment of the globe (retina and choroid); and, finally, panuveitis, when more than one of the previous is involved. Posterior segment involvement may…

Vogt–Koyanagi–Harada Disease

Introduction Vogt–Koyanagi–Harada (VKH) disease is a multisystem autoimmune disease that targets melanocytes. The hallmark is bilateral granulomatous panuveitis with associated serous retinal detachments. It was first described by Alfred Vogt in Switzerland in 1906. In Japan in 1914, Yoshizo Koyanagi described two patients with uveitis, closely resembling sympathetic ophthalmia, but lacking a history of trauma. Japanese ophthalmologist Einosuke Harada described a case of unusual uveitis in…

High Myopia

Introduction High myopia, defined as a spherical equivalent equal or higher than −6 diopters (D) or an axial length ≥26 mm, is one of the leading causes of low vision worldwide. The higher the myopia, the more likely complications can occur, so vision can be damaged. There is an increased in myopic retinopathy from 3.8% to 89.6%, in eyes with a refractive error of <−4 and…

Pachychoroid

Pachychoroid Concept The term pachychoroid was first introduced by K. Bailey Freund and colleagues when describing a series of eyes showing retinal pigment epithelium (RPE) disturbances associated with an abnormally thick choroid but occurring in the absence of subretinal fluid. They termed these findings “pachychoroid pigment epitheliopathy” and suggested that it might be considered a forme fruste central serous chorioretiopathy. However, defining what should be considered…

Central Serous Chorioretinopathy

Central serous chorioretinopathy (CSC) is a disorder characterized by serous retinal detachment and/or retinal pigment epithelium (RPE) detachment. These changes are usually confined to the macula but may be multifocal and more widespread. It is the fourth most common retinal disorder and remains a priority research area due to lack of consensus in the etiology, pathogenesis, definition, diagnostic criteria, and management. This is reflected in the…

Choroidal Neovascularization Secondary to Diseases Other than Age-Related Macular Degeneration

Introduction Choroidal neovascularization (CNV) is an ocular pathology represented by newly formed blood vessels extending above the Bruch’s membrane. Classically, CNV was histopathologically divided into subretinal pigment epithelium (RPE, Gass type 1) and subretinal (Gass type 2). Later, neovascularization with intraretinal origin (type 3, also called retinal angiomatous proliferation) was proposed as another subtype of CNV. While CNV is a principal feature of wet age-related macular…

Neovascular (Wet) Age-Related Macular Degeneration

Introduction Age-related macular degeneration (AMD) is a leading cause of blindness worldwide and is the most common cause of blindness in developed countries. The World Health Organization estimates that 8.7% of global blindness is caused by AMD, with 14 million people worldwide rendered either blind or severely visually impaired as a result. Meta-analyses have shown that age-specific prevalence is similar in populations of Asian and Caucasian…

Choroidal Imaging in Dry Age-Related Macular Degeneration

Introduction Age-related macular degeneration (AMD) affects 7–8 million people in the United States (US) with a prevalence of 6.5% in persons aged 40 years and older, and it is the most common cause of blindness in the Western world. In the 1990s, the prevalence of late-stage AMD (comprising atrophic or neovascular forms) was estimated to be 1.6% in the US, with similar prevalence at that time…

Dystrophies

Dystrophies Retinal dystrophies include a variety of hereditary retinal disorders characterized by progressive atrophy of the retina, retinal pigment epithelium (RPE), and choriocapillaris complex. These dystrophies are generally not choroidal dystrophies, but usually retinal and/or RPE dystrophies that lead to secondary atrophy of the choriocapillaris. The most common disease in this group is retinitis pigmentosa (RP). Other common dystrophies include central areolar choroidal dystrophy (CACD), late…

Choroidal Imaging Techniques: Past, Current, and Future

Introduction The choroid is a highly vascular, pigmented tissue located between the retina and the sclera. The term is derived from the Greek words “form” and “membrane.” It measures 0.22 mm at the posterior pole and from 0.1 to 0.15 mm in its most anterior aspect in a postmortem pathologic sample study. Blood enters the choroid through the short posterior ciliary arteries and is distributed in…

Choroidal Histopathology

Anatomy, Embryology, and Histology of the Choroid The choroid is a pigmented and highly vascularized component of the uveal tract in the eye, allowing for light absorption and providing oxygen and nutrients to the outer retina. Anatomically, the choroid extends from the ora serrata to the optic nerve head and is located at the posterior two-thirds of the eye between the sclera and retina. Anteriorly, it…

Electron Microscopy of the Human Choroid

Introduction The choroid is sandwiched between the sclera and Bruch’s membrane (BM) of the eye. It is the predominant vascular bed of the eye and contains diverse cell types forming the stroma. It performs a number of anatomical, physiological, photoprotective, and immunological functions. Many of these functions are understood from studies employing electron microscopy. This chapter illustrates the structural features of the choroidal elements and how…

Other solutions

Abstract The appearance of the ageing face is a summation of foundation volume loss from recession of underlying skeletal support; skin volume loss from aging, ultraviolet damage and ‘rubbing’, and sagging of support muscles with gravity. Botulinum toxin is ideal for minimising muscle contraction but for full rejuvenation, it is best used in combination with solutions for other changed features. Upper lid bags if present must…