厚脉络膜谱系障碍的争议和难题:一种结构化的诊断方法。

IF 5.9 2区 医学 Q1 OPHTHALMOLOGY
Ramesh Venkatesh, Vishma Prabhu, Pratibha Hande, Karishma Tendulkar, Shruthi Vidyasagar, Rupal Kathare, Nikitha Gurram Reddy, Naresh Kumar Yadav, Alisha Sirsikar, Preksha Biradar, Rupak Roy, Chaitra Jayadev, Soema Tehbla, Priyanka Gandhi, Jay Chhablani
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引用次数: 0

摘要

厚脉络膜(pachychoroid)一词源于希腊语pachy,意为“厚”,指的是一种脉络膜表型,其特征是脉络膜厚度增加,外脉络膜血管扩张(厚血管),以及上覆的Sattler层和脉络膜毛细血管的衰减。这种表型最初在中枢性浆液性脉络膜视网膜病变中被发现,现在被认为是更广泛的视网膜疾病的潜在病理生理基础,包括厚脉络膜色素上皮病、厚脉络膜新血管病变、息肉样脉络膜血管病变、局灶性脉络膜挖掘、乳头周围厚脉络膜综合征、厚脉络膜变性和厚脉络膜地理性萎缩。这些疾病统称为厚脉络膜疾病谱,具有结构脉络膜重塑、脉络膜血管高通透性、外视网膜或视网膜色素上皮改变等共同特征。增强深度成像和扫描源光学相干断层扫描(OCT)、OCT血管造影和超宽视场吲哚菁绿血管造影的引入,极大地扩展了对脉络膜解剖和功能的理解,从而发现了其他特征,如漩涡静脉异常、漩涡静脉间吻合和局限性脉络膜灌注不足。这些见解促使了对疾病分类的重新评估。此外,厚脉络膜驱动的新生血管表现出不同的治疗行为,包括对抗血管内皮生长因子药物的不同反应和光动力疗法的潜在益处。我们探讨了目前有关厚脉络膜病变的病因、疾病分类和治疗的争议,强调了多模态成像在准确诊断中的重要性,并提出了一种临床相关的算法,以帮助眼科医生有效地识别和管理真正的厚脉络膜病变。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Controversies and conundrums in pachychoroid spectrum disorders: A structured diagnostic approach.

The term pachychoroid, derived from the Greek word pachy meaning "thick," refers to a choroidal phenotype characterized by increased choroidal thickness, dilated outer choroidal vessels (pachyvessels), and attenuation of the overlying Sattler layer and choriocapillaris. Initially recognized in central serous chorioretinopathy, this phenotype is now acknowledged as the underlying pathophysiological basis for a broader spectrum of retinal disorders, including pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy, focal choroidal excavation, peripapillary pachychoroid syndrome, pachydrusen and pachychoroid geographic atrophy. Collectively referred to as the pachychoroid disease spectrum, these entities share common features such as structural choroidal remodeling, choroidal vascular hyperpermeability, and outer retinal or retinal pigment epithelial changes. The introduction of enhanced depth imaging and swept-source optical coherence tomography (OCT), OCT angiography, and ultra-widefield indocyanine green angiography has significantly expanded the understanding of choroidal anatomy and function, leading to the identification of additional features such as vortex vein abnormalities, intervortex venous anastomoses, and localized choroidal hypoperfusion. These insights have prompted a reevaluation of disease classification. Moreover, pachychoroid-driven neovascularization demonstrates distinct therapeutic behaviour, including variable responses to anti-vascular endothelial growth factor agents and potential benefit from photodynamic therapy. We explore current controversies related to the etiopathogenesis, disease classification, and treatment of pachychoroid disorders, emphasize the importance of multimodal imaging in accurate diagnosis, and propose a clinically relevant algorithm to help ophthalmologists identify and manage true pachychoroid spectrum disorders effectively.

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来源期刊
Survey of ophthalmology
Survey of ophthalmology 医学-眼科学
CiteScore
10.30
自引率
2.00%
发文量
138
审稿时长
14.8 weeks
期刊介绍: Survey of Ophthalmology is a clinically oriented review journal designed to keep ophthalmologists up to date. Comprehensive major review articles, written by experts and stringently refereed, integrate the literature on subjects selected for their clinical importance. Survey also includes feature articles, section reviews, book reviews, and abstracts.
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