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array:23 [ "pii" => "S2173579423000087" "issn" => "21735794" "doi" => "10.1016/j.oftale.2022.12.001" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "2068" "copyright" => "Sociedad Española de Oftalmología" "copyrightAnyo" => "2022" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "edi" "cita" => "Arch Soc Esp Oftalmol. 2023;98:245-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0365669122002763" "issn" => "03656691" "doi" => "10.1016/j.oftal.2022.12.002" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "2068" "copyright" => "Sociedad Española de Oftalmología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "edi" "cita" => "Arch Soc Esp Oftalmol. 2023;98:245-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "El apogeo de la coroides" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "245" "paginaFinal" => "246" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "The apogee of the choroid" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.I. 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"apellidos" => "Fernández-Vigo" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173579423000087" "doi" => "10.1016/j.oftale.2022.12.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579423000087?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669122002763?idApp=UINPBA00004N" "url" => "/03656691/0000009800000005/v1_202305031342/S0365669122002763/v1_202305031342/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173579423000270" "issn" => "21735794" "doi" => "10.1016/j.oftale.2023.03.002" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "2080" "copyright" => "Sociedad Española de Oftalmología" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "edi" "cita" => "Arch Soc Esp Oftalmol. 2023;98:247-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "The management of the complications and adverse effects at our professional activity" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "247" "paginaFinal" => "248" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La gestión de las complicaciones y efectos adversos en nuestra actividad profesional" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Jiménez Benito, N. Gajate Paniagua, C. Gordon Bolaños" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Jiménez Benito" ] 1 => array:2 [ "nombre" => "N." "apellidos" => "Gajate Paniagua" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Gordon Bolaños" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669123000229" "doi" => "10.1016/j.oftal.2023.01.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669123000229?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579423000270?idApp=UINPBA00004N" "url" => "/21735794/0000009800000005/v1_202305151206/S2173579423000270/v1_202305151206/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "The apogee of the choroid" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "245" "paginaFinal" => "246" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J.I. Fernández-Vigo" "autores" => array:1 [ 0 => array:4 [ "nombre" => "J.I." "apellidos" => "Fernández-Vigo" "email" => array:2 [ 0 => "jfvigo@hotmail.com" 1 => "joseignacio.fernandez-vigo@salud.madrid.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oftalmología, Hospital Clínico San Carlos, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El apogeo de la coroides" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">One of the major subspecialties of ophthalmology is vitreoretinal pathology. Consequently, the different national and international societies or study groups refer to this nomenclature (retina and vitreous) or include the term macula. However, in recent years, mainly due to developments in imaging techniques, the previously neglected choroid has emerged as a key player in the pathophysiology of these retinal conditions.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Accordingly, said enigmatic vascular layer, referred to by various authors as the choroidal labyrinth,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> which nourishes and supports the retina and contributes to ocular homeostasis, was hidden or concealed from the conventional examination. But given the great interest in its key role in multiple chorioretinal diseases, recent advances in imaging techniques have made it possible to analyse the choroid <span class="elsevierStyleItalic">in vivo</span> with a high degree of detail using wide-field indocyanine green angiography, swept-source optical coherence tomography (OCT) and <span class="elsevierStyleItalic">en face</span> OCT. Currently, the medium and large vessel layers of the choroid (Sattler and Haller, respectively) are accessible by OCT and <span class="elsevierStyleItalic">en face</span> OCT, but the study of the choriocapillaris layer remains a challenge.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In recent years, many new measurement parameters or biomarkers have been described in the choroid using OCT. It is no longer sufficient to measure choroidal thickness or choroidal vascular diameter alone: additional parameters such as total choroidal area, vascularisation ratio or reflectivity are also being analysed. Recently, the choroidal vascularity index,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> defined as the ratio between the vascular component and the total choroidal area, seems to have become the most reliable parameter, because it is less influenced by other factors. This type of analysis is currently based on binarization techniques using different software, which make it possible to quantify which part of the choroid corresponds to vascular tissue and which part to stroma, and it has been shown that in healthy subjects, approximately two-thirds of the subfoveal choroid is vascular.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In addition, other characteristics of the choroidal vessels have recently been analysed, such as the presence of pachyvessels (abnormally dilated vessels compressing the choriocapillaris) or vascular anastomoses between the different quadrants of the vortical veins in which there is functional independence in healthy eyes, as well as new characteristics of the choroidal vessels such as drainage asymmetries, bulbosities or sausaging, or choroidal arteriovenous anastomoses.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Thus, the choroid has acquired great prominence in recent years not only because of the obvious alterations it produces in pachychoroid diseases, in which there is dysfunction of the choriocapillaris due to compression, with subsequent damage to the retinal pigment epithelium and accumulation of fluid.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Also, in variants where secondary neovascularization occurs in this pachychoroid spectrum, ischaemia secondary to compression may be the trigger for the onset of neovascularization. On the other hand, it has been observed that in patients with central serous chorioretinopathy, the choroid of the apparently unaffected contralateral eye already has abnormalities within the spectrum of the disease, making patients more prone to develop the disease. Similarly, the still hidden changes to the choroid that occur with the main treatments of choice for this spectrum of disease, photodynamic therapy and subthreshold laser, are gradually being deciphered.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Regarding the ocular changes in diabetes, Lutty already coined the term diabetic choroidopathy, highlighting the remarkable alterations that occur at this level, including reduced subfoveal choroidal flow and choroidal thickness, as well as inflammatory changes.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In addition, impaired choroidal vascularization has been found to be associated with systemic arteriosclerosis.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In relation to age-related macular degeneration, different studies have shown a reduction in the diameter of the choroidal vessels and the density of the choriocapillaris, demonstrating a pathophysiological process in which the choroid is involved. These findings were observed in the two variants of the disease, i.e., the atrophic and neovascular. Thus, the similarity of the changes between the wet and dry variants of the disease point to a common process of choroidal ischaemia, related to the loss of the retinal pigment epithelium in atrophic disease and the onset of neovascularization in neovascular disease.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,10</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">With respect to pathological myopia, chorioretinal atrophy and degenerative changes occur in relation to stenosis and loss of the great choroidal vessels, as well as choriocapillaris occlusion. Therefore, multiple studies describe a thinning of the choroidal thickness in pathological myopia, but the exact structural alterations that cause this reduction are still unknown.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In uveitis, particularly in posterior uveitis and panuveitis, choroidal inflammatory changes play a key role in the development, progression and resolution of the disease. Choroidal vascularity index and increased flow voids in the choriocapillaris are parameters to be taken into account and may be useful both for a correct differential diagnosis and for monitoring the response to treatment.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Interestingly, it has been observed that there is reduced blood flow in glaucoma patients not only in the optic nerve and macula, but also in the choroid. Other conditions, such as hereditary retinal dystrophies, drug toxicity or choroidal vascular tumours, also have choroidal alterations and may also benefit from a deeper and more detailed knowledge of the choroid.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion, choroidal dysfunction plays a key role in multiple ocular diseases and improved imaging techniques, coupled with artificial intelligence-based analysis, already offer an exciting prospect for understanding the choroid in the coming years. Thus, the detailed study of the choroid using reliable parameters will have vast implications for helping the clinician to understand pathogenesis, progression and response to treatment, as well as to design new therapeutic strategies for choroidal diseases.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">No conflict of interest was declared by the author.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exploring the choroidal vascular labyrinth and its molecular and structural roles in health and disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Brinks" 1 => "E.H.C. van Dijk" 2 => "I. Klaassen" 3 => "R.O. Schlingemann" 4 => "S.M. Kielbasa" 5 => "E. Emri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Prog Retin Eye Res [Internet]" "fecha" => "2022" "volumen" => "87" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Choriocapillaris: fundamentals and advancements" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Lejoyeux" 1 => "J. Benillouche" 2 => "J. Ong" 3 => "M.-H. Errera" 4 => "E.A. Rossi" 5 => "S.R. Singh" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Prog Retin Eye Res." "fecha" => "2022" "volumen" => "87" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exploring choroidal angioarchitecture in health and disease using choroidal vascularity index" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Agrawal" 1 => "J. Ding" 2 => "P. Sen" 3 => "A. Rousselot" 4 => "A. Chan" 5 => "L. Nivison-Smith" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Prog Retin Eye Res [Internet]." "fecha" => "2020" "volumen" => "77" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sausaging and bulbosities of the choroidal veins in central serous chorioretinopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.F. Spaide" 1 => "W.K. Ngo" 2 => "I. Barbazetto" 3 => "J.A. Sorenson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/IAE.0000000000003521" "Revista" => array:7 [ "tituloSerie" => "Retina." "fecha" => "2022" "volumen" => "42" "numero" => "9" "paginaInicial" => "1638" "paginaFinal" => "1644" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35507949" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A new insight into pachychoroid diseases: remodeling of choroidal vasculature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Kishi" 1 => "H. Matsumoto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00417-022-05687-6" "Revista" => array:7 [ "tituloSerie" => "Graefes Arch Clin Exp Ophthalmol." "fecha" => "2022" "volumen" => "260" "numero" => "11" "paginaInicial" => "3405" "paginaFinal" => "3417" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35575932" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Venous overload choroidopathy: a hypothetical framework for central serous chorioretinopathy and allied disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.F. Spaide" 1 => "C.M. Gemmy Cheung" 2 => "H. Matsumoto" 3 => "S. Kishi" 4 => "C.J.F. Boon" 5 => "E.H.C. van Dijk" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Prog Retin Eye Res" "fecha" => "2022" "volumen" => "86" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Choroidal arteriovenous anastomoses: a hypothesis for the pathogenesis of central serous chorioretinopathy and other pachychoroid disease spectrum abnormalities" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Brinks" 1 => "E.H.C. van Dijk" 2 => "O.C. Meijer" 3 => "R.O. Schlingemann" 4 => "C.J.F. Boon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/aos.15112" "Revista" => array:7 [ "tituloSerie" => "Acta Ophthalmol." "fecha" => "2022" "volumen" => "100" "numero" => "8" "paginaInicial" => "946" "paginaFinal" => "959" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35179828" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pachychoroid disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.M.G. Cheung" 1 => "W.K. Lee" 2 => "H. Koizumi" 3 => "K. Dansingani" 4 => "T.Y.Y. Lai" 5 => "K.B. Freund" ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1038/s41433-018-0158-4" "Revista" => array:7 [ "tituloSerie" => "Eye [Internet]" "fecha" => "2019" "volumen" => "33" "numero" => "1" "paginaInicial" => "14" "paginaFinal" => "33" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29995841" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1038/s41433-018-0158-4" "WWW" => array:1 [ "link" => "https://doi.org/10.1038/s41433-018-0158-4" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diabetic choroidopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G.A. Lutty" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.visres.2017.04.011" "Revista" => array:6 [ "tituloSerie" => "Vision Res" "fecha" => "2017" "volumen" => "139" "paginaInicial" => "161" "paginaFinal" => "167" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28535994" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relationship between RPE and choriocapillaris in age-related macular degeneration" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D.S. McLeod" 1 => "R. Grebe" 2 => "I. Bhutto" 3 => "C. Merges" 4 => "T. Baba" 5 => "G.A. Lutty" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1167/iovs.09-3639" "Revista" => array:7 [ "tituloSerie" => "Invest Ophthalmol Vis Sci." "fecha" => "2009" "volumen" => "50" "numero" => "10" "paginaInicial" => "4982" "paginaFinal" => "4991" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19357355" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009800000005/v1_202305151206/S2173579423000087/v1_202305151206/en/main.assets" "Apartado" => array:4 [ "identificador" => "82157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorials" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009800000005/v1_202305151206/S2173579423000087/v1_202305151206/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579423000087?idApp=UINPBA00004N" ]
