Wide-Field OCTA Evaluation of Dominant Vortex Veins Among Healthy and Pachychoroid Eyes: Distribution Patterns and...

The purpose of this study was to investigate vortex vein distribution and to compare choroidal parameters between dominant vortex veins (DVVs) and non-DVV (nDVV) regions among healthy eyes and pachychoroid disease (PCD).

This retrospective study used wide-field optical coherence tomography angiography (WF-OCTA) to evaluate DVV number, symmetry, quadrant location, and posterior vortex vein (PVV) presence. Choroidal thickness (CT), choroidal venous volume/area (CVV/a), choroidal stromal volume/area (CSV/a), choroidal vascularity index (CVI), and choroidal stromal index (CSI) were compared between groups and between DVV and nDVV sectors within a 3 × 2 grid.

We analyzed 237 eyes from 162 subjects (65.4% male subjects; mean age = 44.66 ± 6.65 years). DVV asymmetry was higher in PCD groups (UCP 88.9% [95% CI = 77.8%-94.8%], PPE 81.7% [95% CI = 71.2%-89.0%], aCSC 93.1% [95% CI = 84.7%-97.0%]) than healthy eyes (75.0%; 95% CI = 59.8%-85.8%) (P = 0.034). Two-DVV patterns were more common in PCD (45.8% UCP, 53.4% PPE, and 49.3% aCSC) than healthy eyes (25.0%; P = 0.006). PVVs were rare in PCD (0% UCP, 0% PPE, and 2.8% [0.8%, 9.6%] aCSC) compared with healthy eyes (15.0% [7.1%, 29.1%]). DVV sectors showed greater temporal CT than nDVV (ΔCT 26.56-38.40 µm across groups), with prominent temporal pachyvessels in PCD.

WF-OCTA reveals DVV as a prominent venous feature of PCD. DVV regions exhibit greater thickness and vascularity than nDVV, and diseased eyes display enriched DVV asymmetry with infrequent PVVs.

DVV asymmetry may serve as an imaging indicator for identifying and monitoring PCD in clinical practice.