Asymmetry of choroidal venous vascular patterns in the human eye

doi:10.1016/j.ophtha.2003.06.009

Ophthalmology

Volume 111, Issue 3, March 2004, Pages 507-512

https://doi.org/10.1016/j.ophtha.2003.06.009 Get rights and content

Abstract

Purpose

To describe the angioarchitecture of choroidal veins in normal subjects using indocyanine green (ICG) angiography.

Design

Consecutive observational case series.

Participants

Thirty-six eyes of 33 healthy volunteers ranging in age from 21 to 81 years (50.0±18.2 [mean ± standard deviation]).

Methods

Indocyanine green angiography was performed with a modified Topcon fundus ICG camera. Montage images were obtained during the venous phase of the ICG angiogram.

Main outcome measures

Indocyanine green angiographic montage images covering all areas of the observable fundus.

Results

Eighteen of 36 eyes examined (50%) showed asymmetry of choroidal venous vascular patterns consistent with a preferential route of choroidal venous drainage of the macular region. Twelve of the 18 eyes with a preferred drainage route drained superotemporally; the remaining 6 eyes drained by either an inferotemporal or a superonasal route. A preferential choroidal venous drainage route in the macula was identified with equal frequency in young and old subjects. Of 36 eyes examined, 27 (75%) lacked ICG angiographic evidence of symmetric separation of outer choroidal veins.

Conclusions

There is ICG angiographic evidence of asymmetry of choroidal venous drainage in one half of normal individuals. The relative frequency of a resulting preferential drainage route in a group of normal subjects and the equal distribution in young and old subjects indicate that this finding is neither pathologic nor attributable to aging. There is also ICG angiographic evidence for a lack of symmetric separation in the outer choroidal venous system in the majority of normal human subjects tested, indicating that classic watershed zones may not be present or are less prominent in this portion of the choroidal vasculature.

Section snippets

Materials and methods

The subjects were 33 normal healthy volunteers who gave full informed consent to participate in this study. Institutional review board/ethics committee approval was not required for this study. The subjects formed a consecutive case series and had no obvious ophthalmological defects on slit-lamp biomicroscopy or funduscopic examination. All patients were of Asian-Japanese decent. Subjects with refraction over ±3.00 diopters were excluded from this study, as highly myopic eyes may have venous

Montage image analysis demonstrates the preferential direction of choroidal venous drainage in half of normal human subjects

Of 36 eyes examined by montage imaging, 9 (25%) showed findings consistent with watershed zones in the outer choroid. They had horizontal venous separation passing through the optic disc and foveal region. In these 9 eyes, the draining veins were arranged in a symmetric fashion and divided into upper and lower parts, thus defining the horizontal meridian. The vertical division was relatively less well defined by ICG angiography relative to the horizontal division. However, venous drainage was

Discussion

Symmetry of choroidal venous drainage has been previously proposed.2, 13 This study presents evidence of a preferential (asymmetric) distribution of macular choroidal veins in half of normal subjects aged 21 to 81 years. Two thirds of the eyes with a preferential direction of drainage had a superotemporal route, whereas the others had either an inferotemporal or a superonasal route. The preferential drainage route was identified equally in young and old normal subjects, indicating that the

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Vortex Veins in Eyes With Pachychoroid Spectrum Disorders Evaluated by the Adjusted Reverse 3-Dimensional Projection Model
2023, Ophthalmology Science
To compare the distribution of vortex vein ampulla (VVA) between pachychoroid spectrum disorder (PSD) and controls.
A single-center, case-control study.
This study included 75 PSD, 35 fellow, and 65 control eyes.
We quantified VVA distribution using a 3-dimensional reverse projection model corrected for image distortion. We investigated the distribution of major drainage veins (MDV), in which macular Haller's vessels directly influx.
The mean distances from the optic disc to VVAs and the mean angles between VVAs and the fovea-disc line.
The PSD group had significantly fewer VVA in infranasal sector (PSD, fellow, control; 1.6 ± 0.6, 1.8 ± 0.6, 1.9 ± 0.6, respectively, P = 0.026). In supralateral sector, for PSD, fellows, and controls, the mean distances from the optic disc to VVAs were 14.1 ± 1.0 mm, 14.1 ± 1.1 mm, and 13.6 ± 1.4 mm, respectively, and were significantly farther in PSD than in controls (P = 0.023). The mean angles between VVAs and the fovea-disc line were 64.8 ± 5.9°, 66.4 ± 6.4°, and 61.7 ± 6.4°, respectively, and were significantly higher in PSD and fellows than in controls (P = 0.008). The mean distances from the optic disc to MDV in supratemporal sector were 14.1 ± 1.2 and 13.7 ± 1.2 in eyes whose Haller's vessels extended beyond the fovea-disc line (asymmetry), and those that did not, respectively, with the asymmetric eyes significantly farther (P = 0.016).
The VVA position in supralateral sector was farther and higher in PSD than in controls, suggesting that the distribution of VVA may be associated with the development of PSD.
Proprietary or commercial disclosure may be found after the references.
En face Ultrawidefield OCT of the Vortex Vein System in Central Serous Chorioretinopathy
2023, Ophthalmology Retina
Citation Excerpt :
Our measurements of the choroidal venous drainage distribution on en face UWF OCT were consistent with UWF ICGA–based studies showing imbalanced drainage within the vortex vein system in most eyes with CSC.9,19,20 Importantly, asymmetric vortex vein drainage has been reported in 38% to 50% of normal eyes, and occurred preferentially in the temporal quadrants.14,21 However, the incidence of imbalanced vortex vein drainage was higher in CSC eyes than that in control eyes, suggesting that this feature may be an anatomic predisposition to CSC development.9
To investigate whether noninvasive en face ultrawidefield (UWF) OCT can demonstrate salient features of the choroidal vasculature in eyes with central serous chorioretinopathy (CSC).
Retrospective observational case series.
Patients diagnosed with CSC who underwent UWF indocyanine green angiography (ICGA) and widefield OCT imaging were included.
Widefield OCT imaging was performed with a horizontal 23-mm × vertical 20-mm field of view of 5 visual fixations (1 central and 4 peripheral fixations) to compose structural en face UWF OCT montage images and UWF choroidal thickness maps. Automated image alignment was performed before grading.
A comparison of choroidal vascular findings seen with UWF ICGA and en face UWF OCT images, including size and distribution of choroidal venous drainage areas and identification of dilated choroidal veins (pachyvessels) crossing the physiologic choroidal watershed zones. The spatial correlation between choroidal vascular hyperpermeability on UWF ICGA images and areas of choroidal thickening on UWF choroidal thickness maps was determined.
Forty-two eyes from 27 patients with CSC with a mean age of 56 ± 12 years (range, 31–77 years) were included. Quantitative measures of vortex vein drainage areas on en face UWF OCT images were significantly and positively correlated with those obtained with UWF ICGA (mean Pearson r = 0.825, P < 0.01). Identification of pachyvessels crossing the choroidal watershed zones showed an excellent correlation between UWF ICGA and en face UWF OCT images (mean Spearman ρ = 0.873, P < 0.01). In all cases, choroidal vascular hyperpermeability was observed on UWF ICGA spatially colocalized with areas of choroidal thickening on the UWF choroidal thickness map. Congestion within the entire drainage area of the dominant vortex systems was observed on UWF choroidal thickness maps.
In eyes with CSC, noninvasive en face UWF OCT imaging can show distinctive features of choroidal venous insufficiency previously identified with UWF ICGA. Ultrawidefield OCT choroidal thickness maps enable quantitative assessment of choroidal congestion.
Proprietary or commercial disclosure may be found after the references.
Factors effecting the choroidal vascularity index in children with mild to moderate myopia
2022, Photodiagnosis and Photodynamic Therapy
Citation Excerpt :
In recent years, the choroidal vascularity index (CVI) has been of great interest for researchers as an objective marker of the choroidal vasculature. Previous imaging techniques were limited to a two-dimensional visualization of the choroid, and only large vessels could be quantified.[20–23] The enhanced-depth imaging (EDI) optical coherence tomography (OCT) enabled the visualization of three-dimensional choroidal vasculature with more clear images.[24–27]
To measure the choroidal structural parameters in a population of myopic children and determine the factors effecting the choroidal vascularity index (CVI).
:In total, 200 eyes of 200 children (100 females, 100 males) with a mean age of 11.5 ± 1.6 years were included in the study. Macular imaging was performed using EDI mode of spectral domain-optical coherence tomography. Binarization of the choroidal area was performed with ImageJ software. Total choroidal area, luminal area (LA), stromal area (SA), and CVI were automatically calculated.
The mean choroidal, stromal and luminal areas were measured as 0.952 ± 0.127 mm², 0.626 ± 0.103 mm² and 0.325 ± 0.076 mm², respectively. The mean CVI was 65.81% ± 6.56. Age and the axial length (AL) of the participants were not found to be associated with the LA and the CVI. (r=-0.078, p=0.274, r=0.017, p=0.808, and r=0,051, p=0.474 and r=-0.128, p=0.071, respectively). There was a statistically significant strong association between the LA and CVI measurements and SE of the participants (r=0.736, p=0.001, and r=-0.605; p=0.001).
Age and AL were not associated with the CVI, but SE was significantly associated with the CVI.
Short Axial Length Is Related to Asymmetric Vortex Veins in Central Serous Chorioretinopathy
2021, Ophthalmology Science
To investigate the clinical and morphologic factors related to asymmetric dilated vortex veins in central serous chorioretinopathy (CSC).
Retrospective, comparative study.
One hundred fifty-eight eyes of 158 patients with CSC.
All patients with CSC underwent ophthalmic examination and multimodal imaging, including measurements of axial length (AL), fluorescein angiography, indocyanine green angiography, swept-source OCT, and anterior segment OCT. Using en face OCT images at the level of the outer choroid, the eyes were divided into 2 groups: eyes with symmetric vortex veins (symmetry group) and those with asymmetric vortex veins (asymmetry group).
Clinical and morphologic factors related to asymmetric vortex veins in CSC.
Of the 158 eyes, 120 eyes (75.9%) were classified into the asymmetry group and 38 eyes (24.1%) were classified into the symmetry group. The asymmetry group showed significantly greater spherical equivalent (–0.32 ± 1.78 diopters [D] vs. –1.35 ± 2.64 D; P = 0.033), shorter AL (23.52 ± 0.86 mm vs. 24.10 ± 1.06 mm; P = 0.005), and greater subfoveal choroidal thickness (414.6 ± 105.3 μm vs. 360.4 ± 91.8 μm; P = 0.005) than the symmetry group. No significant differences existed between the 2 groups regarding age, sex, or all scleral thicknesses at the superior, temporal, inferior, and nasal points. In the multivariate analyses, shorter AL (odds ratio, 0.56; 95% confidence interval, 0.36–0.88; P = 0.011) was found to be significantly associated with the presence of asymmetric vortex veins.
The asymmetric dilated vortex vein is a common finding in patients with CSC. Our results suggest that certain biometric factors, such as short AL, may be associated with asymmetric dilated vortex veins developing in patients with CSC.
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To develop a method to obtain ultra-widefield choroidal vessel images with a fundus camera without using dye, and its application in Vogt-Koyanagi-Harada (VKH) disease.
Experimental study and case series.
Patients with unilateral retinal disorders and those with VKH disease who had undergone ultra-widefield imaging were studied.
Indocyanine green angiography (ICGA) and the 635-nm wavelength Optos ultra-widefield fundus photography (Optos, United Kingdom) images (Optos_635-nm) were processed by KagoEye 3 software. The 2 types of images were overlapped. The degree of overlapped blood vessel areas of the ICGA image was taken as the matching ratio. The matching ratio was obtained for the peripheral, posterior pole, and overall areas. In addition, changes in the fundus findings were followed up with Optos_635-nm image analysis in patients with VKH disease. The degree of visibility of the choroidal vessels was evaluated for 5 stages. The clarity scores and the longitudinal findings were compared.
The matching ratios between the ICGA images and the Optos_635-nm images processed by KagoEye3 software were determined.
Initially, 10 healthy eyes were studied. The matching ratios for the overall area, the peripheral area, and the posterior pole area of the ICGA image and the Optos_635-nm image were 64.09%, 74%, and 63.10%, respectively. The correlations between the choroidal blood vessel matching ratio and the ocular axial length and refractive error were not significant, but the matching ratio was correlated significantly with the age. The average clarity score in 12 VKH disease patients was 1.6 ± 0.85 before treatment, which was significantly improved to 4.2 ± 0.75 after 1 month (P < 0.05). Many hyporeflective spotty lesions were observed on the Optos_635-nm images, which coincided with hyperfluorescent dots on the ICGA images. The lesions gradually disappeared and the vortex vein became visible after treatment.
The ultra-widefield Optos_635-nm images processed by KagoEye3 software can exaggerate images of the choroidal vessels in widefield fundus images without using dye. Because this method is noninvasive, it is applicable to a variety of diseased and healthy eyes.
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Manuscript no. 220961.

Supported in part by a grant-in-aid for scientific research (11771070) from the Ministry of Education, Culture and Science, Japan.

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Original articleAsymmetry of choroidal venous vascular patterns in the human eye☆

Abstract

Purpose

Design

Participants

Methods

Main outcome measures

Results

Conclusions

Section snippets

Materials and methods

Montage image analysis demonstrates the preferential direction of choroidal venous drainage in half of normal human subjects

Discussion

Exp Eye Res

Ophthalmology

Ophthalmology

Am J Ophthalmol

Occlusion of the posterior ciliary artery. I. Effects on choroidal circulation

Br J Ophthalmol

Occlusion of the vortex veinsan experimental study

Br J Ophthalmol

Submacular choroidal vascular patternexperimental fluorescein fundus angiographic studies

Albrecht Von Graefes Arch Klin Exp Ophthalmol

The choriocapillaris

Albrecht Von Graefes Arch Klin Exp Ophthalmol

Segmental nature of the choroidal vasculature

Br J Ophthalmol

Choroidal vascular ischemia

Eye

Structure of Ocular Vessels

Original article
Asymmetry of choroidal venous vascular patterns in the human eye☆