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Sakurada, Yoichi, MD, PhD*,†,‡; Leong, Belinda C. S., MD*,†; Parikh, Ravi, MD, MPH*,†; Fragiotta, Serena, MD*,†,§; Freund, K. Bailey, MD*,†,¶,**

doi: 10.1097/IAE.0000000000002294
Original Study

Purpose: To investigate the association between choroidal caverns, choroidal vascular hyperpermeability (CVH), and pachyvessels in eyes with pachychoroid disease.

Methods: This was a retrospective review of swept-source optical coherence tomography and indocyanine green angiography imaging performed on eyes with pachychoroid disease.

Results: Imaging from 21 eyes with pachychoroid disease entities (8 eyes with pachychoroid pigment epitheliopathy, 11 eyes with central serous chorioretinopathy, and 3 eyes with pachychoroid neovasculopathy) from 11 patients (mean 49.5 years, male/female: 10/1, all white) was available for review. In all study eyes, pachyvessels traversed the areas of CVH visible in mid- and late-phase indocyanine green angiography. A total of 504 choroidal caverns were identified in 11 study eyes (52%). Of the 504 choroidal caverns, 445 (88%) were seen within the areas of CVH compared with 59 (12%), which were detected outside the areas of CVH (P < 0.001). Eyes with multiple caverns had an increased choroidal thickness when compared with eyes with ≤1 cavern (P < 0.001).

Conclusion: Choroidal caverns, found primarily in the areas of indocyanine green angiography CVH traversed by pachyvessels, were detected in 52% of eyes with pachychoroid disease. The presence of choroidal caverns in these cases may indicate a loss of normal choroidal architecture associated with dilated Haller layer veins and increased choroidal thickness.

In pachychoroid disease, the presence of choroidal caverns may indicate a loss of normal choroidal architecture associated with dilated Haller layer veins and increased choroidal thickness.

*Vitreous Retina Macula Consultants of New York, New York, New York;

LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York;

Departments of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan;

§Department of Medico-Surgical Sciences and Biotechnologies, UOC Ophthalmology, Sapienza University of Rome, Rome, Italy;

Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York; and

**Department of Ophthalmology, New York University of Medicine, New York, New York.

Reprint requests: K. Bailey Freund, MD, Vitreous Retina Macula Consultants of New York, 460 Park Avenue, New York, NY 10022; e-mail:

Supported by the LuEsther T. Mertz Center for Retinal Research and the Macula Foundation Inc, New York, NY. The funding bodies had no role in the design or execution of this study or the decision to publish. S. Fragiotta was also supported by H2CU-Honors Center of Italian Universities.

Y. Sakurada: a lecturer for Novartis, Bayer, Kowa, and Santen. K. B. Freund: a consultant to Optovue, Zeiss, Novartis, Spark Therapeutics, and Heidelberg Engineering and receives research support from Genentech/Roche. The remaining authors have no any financial/conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.