The spectrum of pachychoroid neovasculopathy

To provide a comprehensive overview of pachychoroid neovasculopathy (PNV), focusing on its current understanding in terms of clinical behavior, multimodal retinal imaging characteristics, and treatment.

A narrative review of the literature on PNV was conducted using the following keywords: pachychoroid neovasculopathy, pachychoroid, pachychoroid disease spectrum, pachychoroid pigment epitheliopathy, central serous chorioretinopathy, polypoidal choroidal vasculopathy.

PNV is a clinical entity within the pachychoroid disease spectrum, typically presenting as type 1 choroidal neovascularization (CNV). It may arise either directly from pachychoroid pigment epitheliopathy (PPE) without prior central serous chorioretinopathy (CSC) or from chronic CSC. PNV is frequently misdiagnosed as neovascular age-related macular degeneration (nAMD), particularly in patients older than 50 years, making multimodal retinal imaging essential for distinguishing its characteristic features from CNV secondary to AMD. The therapeutic management of PNV depends on its underlying initial condition and differs from the treatment strategy for CNV secondary to AMD.

Recognizing PNV as a distinct entity is crucial for optimizing diagnosis and treatment. Multimodal retinal imaging is essential to ensure appropriate therapeutic management.

What is known? Pachychoroid neovasculopathy (PNV) is a distinct clinical entity within the pachychoroid disease spectrum, frequently misdiagnosed as neovascular age-related macular degeneration (nAMD). What is new? PNV includes subtypes arising from pachychoroid pigment epitheliopathy or chronic central serous chorioretinopathy, which differ in treatment responses and strategies. Multimodal retinal imaging plays an essential role in differentiating PNV from nAMD. The lack of standardized diagnostic criteria for PNV highlights the need for shared definitions to improve PNV classification, patient stratification, and treatment selection.