Rev Bras Oftalmol.2025;84(Supl. 3):ex0004
Updated review of the pachychoroid spectrum and central serous chorioretinopathy
DOI: 10.37039/1982.8551.2025S3ex0004
ABSTRACT
The pachychoroid disease spectrum (PDS) encompasses a range of chorioretinal disorders characterized by increased choroidal thickness, dilated Haller’s layer vessels (pachyvessels), and choroidal hyperpermeability, often associated with retinal pigment epithelium (RPE) alterations. This review synthesizes current evidence on pachychoroid pigment epitheliopathy (PPE), central serous chorioretinopathy (CSC), pachychoroid neovasculopathy (PNV), and polypoidal choroidal vasculopathy (PCV), emphasizing their shared pathophysiological mechanisms, multimodal imaging features, and clinical implications. Enhanced depth imaging optical coherence tomography (EDI-OCT) and widefield indocyanine green angiography (ICGA) have been crucial in identifying vortex vein congestion and segmental choroidal drainage anomalies as central pathogenic drivers. Clinically, this framework supports a phenotype-based approach, where anti-VEGF therapy is prioritized for neovascular phenotypes (PNV, PCV) and photodynamic therapy (PDT) is effective for chronic, hyperpermeable non-neovascular CSC. Despite advances, challenges remain regarding standardized diagnostic thresholds, early phenotype detection, and the influence of systemic factors. The integration of hemodynamic concepts, vascular anatomy, and advanced imaging is key to developing personalized management strategies across the pachychoroid spectrum.