Pachychoroid Worsens Clinical Outcomes in Central Serous Chorioretinopathy

Pachychoroid worsens visual acuity in individuals with central serous chorioretinopathy (CSC), and may lead to more recurrent CSC episodes, and less spontaneous CSC resolution compared with eyes with CSC without pachychoroid, according to research published in Eye.

Researchers included 250 individuals with CSC (mean age, 46.6 years; 88.4% men) in a retrospective, longitudinal, record-based study designed to compare the clinical features and outcomes of eyes with CSC with and without pachychoroid (both n=125). A subfoveal choroidal thickness of 300 µm or thicker and the presence of pachyvessels were used to discriminate eyes with pachychoroid from eyes without pachychoroid. Study participants underwent spectral domain-optical coherence tomography (SD-OCT), and the team monitored visual acuity changes, spontaneous CSC resolution, and CSC recurrence during a mean 6.73 (range, 6-17) month follow-up period.

While there were no significant differences in baseline best-corrected visual acuity (BCVA) between the pachychoroid and non-pachychoroid groups (0.40 vs 0.39; P=.9), individuals with pachychoroid had worsened BCVA at follow-up compared with participants without pachychoroid (0.37 vs 0.21; P=.04). 

Spontaneous CSC resolution was more likely to occur in eyes without pachychoroid compared with eyes without pachychoroid (48% vs 28.8%; P=.007), and CSC was less likely to recur in these patients (31.2% vs 10.4%; P=.003). Retinal pigment epithelium (RPE) detachment was also more common among individuals with pachychoroid (P =.01).

“Since CSC was known to have thicker choroid than normal eyes even before the advent of the concept of pachychoroid, it was imperative that CSC featured predominantly in the pachychoroid spectrum,” according to the researchers. “However, with the evolving body of evidence, it is now understood that it is not merely the absolute thickness but the choroidal morphology which was driving the pathophysiological changes behind the clinical entities of pachychoroid spectrum.”

Study limitations include a retrospective nature, an inability to evaluate fluorescein leakage, and inconsistencies in the diagnostic criteria for determining subfoveal choroidal thickness in pachychoroid.