Progression of choriocapillaris flow deficit in eyes with drusenoid pigment epithelial detachment

To quantitatively evaluate choriocapillaris flow deficits (CCFD) in eyes with drusenoid pigment epithelial detachment (PED) and examine their associations with disease progression and visual outcomes.

This retrospective longitudinal cohort study included 42 eyes with drusenoid PED. Choriocapillaris flow deficit percentage (CCFD%) was quantified using compensation-corrected OCTA imaging with standardized thresholding algorithms. Longitudinal changes in CCFD%, risk factors for geographic atrophy (GA) progression, and predictors of final best-corrected visual acuity (BCVA) were analyzed.

Mean baseline CCFD% was 36.26 ± 5.06%, with gradual worsening over 4 years to 38.47 ± 5.34% (0.60 ± 2.06%/year, P = .012). Eyes progressing to GA demonstrated significantly higher baseline CCFD% than stable eyes (37.94 ± 2.31% vs. 35.12 ± 6.07%, P < .001). During follow-up, 17 eyes (40.5%) developed GA, 23 (54.8%) remained stable, and 2 (4.8%) progressed to neovascular AMD. Multivariate Cox regression identified baseline CCFD (HR, 1.804; P = 0.006) and annual CCFD change rate (HR, 2.262; P = .024) as independent risk factors for GA progression. Multiple linear regression demonstrated that baseline CCFD and CCFD change rate independently predicted final BCVA (adjusted R2 = 0.961, P < .001).

Both baseline CCFD and progressive CCFD deterioration serve as independent predictors of anatomical and functional outcomes in drusenoid PED, emphasizing the pathophysiological role of choroidal hemodynamic dysfunction in AMD progression.