Distinguish polypoidal choroidal vasculopathy through choroidal alterations: A systematic review, meta-analysis and narrative synthesis.
Qing Zhao, Zhixuan Xie, Xinyu Zhao et al.
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In 30 seconds
This systematic review and meta-analysis examined choroidal structural and vascular features of polypoidal choroidal vasculopathy (PCV) compared with healthy controls, fellow eyes, neovascular age-related macular degeneration (nAMD), and pachychoroid disorders. Forty studies were included. Subfoveal choroidal thickness was greater in PCV than in healthy controls, nAMD, and fellow eyes, but lower than in central serous chorioretinopathy and pachychoroid neovasculopathy (all p < 0.05). Other analyses suggested differences in vascularity and choroidal layers, with some findings based on limited evidence.
Key findings
- Subfoveal choroidal thickness was greater in PCV than in healthy controls, nAMD, and fellow eyes, but lower than in central serous chorioretinopathy and pachychoroid neovasculopathy (all p < 0.05).
- Compared with healthy controls, PCV eyes had lower choroidal vascularity index within the standard 1.5 mm subfoveal width and higher choroidal vascular density within the r = 10 mm field of view (p < 0.05).
- Exploratory analyses suggested greater total choroidal thickness in PCV than in healthy controls and nAMD, and a higher Haller-layer-to-subfoveal-thickness ratio and larger luminal area than in nAMD at specific locations or areas.
Why it matters
The findings support distinguishing PCV from nAMD and other pachychoroid disorders using choroidal features, rather than treating it as simply a subtype of nAMD. The differing thickness and vascularity patterns across comparator conditions may help clarify PCV’s place within the pachychoroid spectrum, while variation by PCV subtype and measurement approach underscores the need to interpret individual imaging features in context.
What to keep in mind
Several outcomes were supported by fewer than three studies and were assessed through narrative synthesis or exploratory meta-analysis; the abstract notes that choroidal characteristics have been inconsistently reported.