Pachychoroid disorders of the macula

Pachychoroid Disorders of the Macula are a group of eye conditions characterized by a thickening of the choroid, the vascular layer of the eye located between the retina and the sclera. These disorders can lead to various degrees of vision impairment, including central vision loss. The term "pachychoroid" stems from the Greek words pachy, meaning thick, and choroid, referring to the eye's vascular layer. The macula, the central part of the retina responsible for high-resolution vision, is particularly affected in these conditions.

Etiology and Pathogenesis

Pachychoroid disorders are believed to be caused by a combination of genetic and environmental factors. The thickening of the choroid is thought to result from congestion of the choroidal vessels, leading to increased hydrostatic pressure and subsequent changes in the overlying retinal pigment epithelium (RPE) and retina. This can result in a spectrum of diseases, including Central Serous Chorioretinopathy (CSCR), Pachychoroid Pigment Epitheliopathy (PPE), and Polypoidal Choroidal Vasculopathy (PCV).

Clinical Features

Patients with pachychoroid disorders may present with symptoms ranging from mild to severe visual impairment. Common symptoms include blurred vision, dark spots in the visual field, and metamorphopsia (distorted vision). On examination, features such as thickened choroid, dilated choroidal vessels (Hallmark of pachychoroid spectrum diseases), and RPE alterations can be observed.

Diagnosis

Diagnosis of pachychoroid disorders involves a comprehensive eye examination, including:

• Optical Coherence Tomography (OCT): High-resolution imaging to assess the structure of the retina and choroid.
• Fundus Autofluorescence (FAF): Imaging to evaluate the health of the RPE.
• Indocyanine Green Angiography (ICGA): Used to visualize choroidal vasculature and identify any abnormal blood vessels.

Treatment

Treatment options vary depending on the specific pachychoroid disorder and the severity of the condition. They may include:

• Observation for mild cases.
• Photodynamic therapy (PDT) for certain types of lesions.
• Anti-VEGF (Vascular Endothelial Growth Factor) injections for neovascular complications.
• Laser therapy for specific indications.

Prognosis

The prognosis for patients with pachychoroid disorders varies widely based on the specific condition and its severity. Early detection and appropriate management are crucial for preserving vision.

Prevention

Currently, there are no established methods for preventing pachychoroid disorders. However, regular eye examinations can help in early detection and management of these conditions.

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  Central serous chorioretinopathy with increased choroidal thickness