Pachychoroid: current concepts on clinical features and pathogenesis
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REVIEW ARTICLE
Pachychoroid: current concepts on clinical features and pathogenesis Veronica Castro-Navarro 1 & Francine Behar-Cohen 2,3 & Woohyok Chang 4 & Antonia M. Joussen 5 & Timothy Y. Y. Lai 6 & Rafael Navarro 7 & Ian Pearce 8 & Yasuo Yanagi 9,10 & Annabelle A. Okada 11 Received: 19 May 2020 / Revised: 28 August 2020 / Accepted: 17 September 2020 # The Author(s) 2020
Abstract Purpose The term “pachychoroid” refers to a newly described phenotype in which functional and structural choroidal changes are thought to play a key pathogenic role in a spectrum of related retinal disorders. A more detailed understanding of how the choroid is involved within this spectrum and a better knowledge of the most relevant clinical signs of the pachychoroid phenotype are important to differentiate these disorders from other retinal conditions. Our objectives are to provide a literature review of pachychoroid and the commonalities that may be present across pathologies included in the spectrum, and to provide details on the examination, monitoring, and management of these disorders. Methods We searched the PubMed web platform to identify relevant studies using the following keywords: pachychoroid, pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, aneurysmal type 1 neovascularization, focal choroidal excavation, peripapillary pachychoroid syndrome, vasculopathy pachysclera, pachychoroid geographic atrophy, and pachydrusen. We selected 157 publications and identified the most important features related to pachychoroid. Results The presence of hypertrophic or congested vessels in the choroid, not thickened choroid per se, under an area of reduced or absent choriocapillaris in the posterior pole seems to be the most salient feature of pachychoroid. However, other qualitative/ quantitative features are needed to differentiate the uncomplicated pachychoroid from the pathological pachychoroid clinical spectrum, which may be associated with exudation, neovascularization, and/or retinal pigment epithelium and photoreceptor atrophy. Conclusions The most salient feature of pachychoroid appears to be the presence of large vessels under an area of reduced or absent choriocapillaris. Knowledge of the features and pathogenesis of the different disorders in the pachychoroid spectrum may assist in the management of patients.
* Annabelle A. Okada [email protected] 1 2
3
6
Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
7
Institute of Ocular Microsurgery, Barcelona, Spain
8
Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Ophtalmopole, Paris, France
Royal Liverpool University Hospital, Liverpool, UK
9
Centre de Recherche des Cordeliers UMRS1138, INSERM, Paris, France
Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
10
Singapore National Eye Centre, Singapore, Singapore
11
Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
Hospital General Universitario de Valencia, Valencia, Spain
4
Chang’s Retina Ce
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