Photoreceptor damage in pachychoroid pigment epitheliopathy

To investigate the relationship between choriocapillaris perfusion and photoreceptor integrity in pachychoroid pigment epitheliopathy (PPE).

We compared 44 PPE eyes with 30 healthy controls using swept-source OCT angiography to analyse ellipsoid zone reflectivity, choriocapillaris flow deficit percentage (FD%) and retinal capillary perfusion.

PPE eyes showed significantly reduced EZ reflectivity compared to controls (0.73 ± 0.10 vs 0.79 ± 0.05, p = 0.014), increased choriocapillaris ischemia (CC FD%: 46.6 ± 6.3 vs 32.5 ± 2.9, p < 0.001), and reduced deep capillary plexus perfusion (33.1 ± 4.6 vs 38.6 ± 3.3, p < 0.001). Multiple regression analysis revealed a significant inverse association between increased CC ischemia and reduced EZ reflectivity (r = -0.364, p < 0.001).

Choriocapillaris ischemia significantly correlates with photoreceptor damage in PPE, suggesting vascular dysfunction as a key pathogenic mechanism.