Presentation and Course of Pachyvitelliform Maculopathy: A Case Series and Mini-Review

Pachyvitelliform maculopathy (PVM) is a novel phenotype within the spectrum of pachychoroid disorders featuring subretinal fluid and yellowish, hyperreflective, and hyperautofluorescent deposits. This study aimed to characterize PVM through multimodal imaging and evaluate therapeutic responses to guide clinical management.

This retrospective study analyzed patient records from 2020 to 2025 at two ophthalmic centers. PVM was diagnosed based on subretinal hyperreflective material on optical coherence tomography (OCT), hyperautofluorescence, and increased choroidal thickness (>350 μm). Macular neovascularization was excluded via OCT angiography, fluorescein angiography (FA), and OCT. Outcomes following half-dose photodynamic therapy (hd-PDT) and subthreshold micropulse laser (SML) were evaluated. Seven patients with PVM were identified. At baseline, visual acuity did not exceed 0.5 Snellen in any case. Two eyes received hd-PDT (including one treated with combined SML and PDT), four received SML exclusively, and one was managed with observation only. Improvement in best corrected visual acuity occurred in 2 cases. While significant morphological restoration was observed in two eyes, it was also accompanied by atrophy of the outer retinal layers and retinal pigment epithelium. Only one patient achieved significant functional improvement following hd-PDT. One patient demonstrated the progressive evolution of vitelliform-like lesions from a simple form of central serous chorioretinopathy (CSC) over 60 months in the absence of prompt treatment.

PVM represents a diagnostic challenge, often necessitating multimodal imaging to reliably distinguish it from macular dystrophies. Further large-scale studies are required to better establish the efficacy of available therapeutic approaches. Nevertheless, treatment modalities commonly employed in the management of CSC, such as PDT and SML, currently remain among the most viable options.