Pachychoroid Disease - Posterior Segment & Ocular Disease Spring 2026

-Enhanced-depth imaging (EDI-OCT)

-Swept Source OCT (SS-OCT)

What technology would you use to diagnose pachychoroidal disease?

-enhanced imaging of the choroid

-choroidal thickness measurements

What do Enhanced-depth imaging (EDI-OCT) & Swept Source OCT (SS-OCT) allow for?

Focal or diffuse choroidal thickening (>400 microns) d/t dilation of choroidal vessels in Haller's layer (more external)

What happens to the choroid in pachychoroidal disease?

leakage of these vessels

Dilation of the vessels in Haller's layer of the choroid can lead to what?

thinning of the choriocapillaris and Sattler's layer

Dilation of the vessels in Haller's layer of the choroid can lead to thinning of what other layer?

RPE abnormalities and sometimes photoreceptor abnormalities & atrophy

What can pachychoroidal disease be associated with?

hyper

In pachychoroidal disease, the vessels in Haller's layer will be (hyper/hypo) permeable

Yes

Are choroidal filling defects (reduced perfusion) associated with pachychoroidal disease?

-retinal changes that seem like AMD (serous fluid, serous detachments, drusenoid-like detachments, hemorrhages, hard exudate)

What does pachychoroidal disease lead to?

younger

Patients with pachychoroidal disease may be ____ than a typical AMD patient

true

True or False:

A patient with pachychoroidal disease will probably NOT have large drusen?

-Photodynamic therapy (PDT)

-Combo PDT and Anti-VEGF meds

Pachychoroidal disease sometimes responds well to _______

-Central serous chorioretinopathy (CSC)

-Pachychoroid Pigment Epitheliopathy (PPE)

-Pachychoroid Neovasculopathy (PVN)

-Polypoidal Choroidal Vasculopathy/Aneurysmal Type 1 Neovascularization (PCV/AT1)

-Focal Choroidal Excavation (FCE)

-Peripapillary Pachychoroid Syndrome (PPS)

What are the different kinds of pachychoroidal disease?

Central Serous Chorioretinopathy on OCT (Pic)

Central Serous Chorioretinopathy on OCT (Pic)

Serous retinal detachment d/t leakage of vessels in the choroid

What is shown in this pic?

Central serous chorioretinopathy with Large Pachyvessels (Pic)

Central serous chorioretinopathy with Large Pachyvessels (Pic)

Yes? They will have the problem in both eyes but may not progress to a retinal detachment in both

Is central serous bilateral?

Central Serous Chorioretinopathy and Focal Choroidal Excavation (Pic)

Central Serous Chorioretinopathy and Focal Choroidal Excavation (Pic)

thinned choriocapillaris and Sattler's layer of the choroid

Why does a focal choroidal excavation present?

Dunno

Does FCE only occur in pachychoroidal disease?

Pachychoroidal Pigment Epitheliopathy (PPE) -- Choroidal Hyperpermeability with Pachydrusen and Possibly Retinal Pigmentary Disruption (Pic)

Pachychoroidal Pigment Epitheliopathy (PPE) -- Choroidal Hyperpermeability with Pachydrusen and Possibly Retinal Pigmentary Disruption (Pic)

No -- OCT will show no evidence of neovascularization

On OCT-A will there be vessels in the outer retina of a patient with Pachychoroidal Pigment Epithelialopathy?

Pachychoroidal Neovasculopathy (PVN) -- Choroidal Hyperpermeability and T1 Neovascularization (Pic)

Pachychoroidal Neovasculopathy (PVN) -- Choroidal Hyperpermeability and T1 Neovascularization (Pic)

Neovasc

What is present in the outer retina of Pachychoroidal Neovasculopathy (PVN)?

Prob

Will the neovasc in Pachychoroidal Neovasculopathy (PVN) leak?

Choroidal Neovasc Membrane located below the RPE

Type 1 ("Occult") Choroidal Neovasc

Choroidal Neovasc Membrane that grows through the RPE into the subretinal space

Type 2 ("Classic") Choroidal Neovasc

Retinal angiomatous proliferation; retinal neovascularization that moves posteriorly

Type 3 Choroidal Neovasc

Polypoidal Choroidal Vasculopathy/Aneurysmal Type 1 Neovascularization (PCV/AT1)

Polypoidal Choroidal Vasculopathy/Aneurysmal Type 1 Neovascularization (PCV/AT1)

Aneurysms of the choroidal vessels

What are these bright bulbs on OCT-1?

-Serous Detachment

-RPE Detachment

-In the presence of choroidal aneurysms in the same place

What is present in this pic?

Yes

Does Polypoidal Choroidal Vasculopathy/Aneurysmal Type 1 Neovascularization (PCV/AT1) usually have neovasc associated with it?

PDT w/ possible Anti-VEGF meds

What is Polypoidal Choroidal Vasculopathy/Aneurysmal Type 1 Neovascularization (PCV/AT1) treated with?

Peripapillary Pachychoroid Syndrome (PPS) -- Maximum Choroidal Thickness Close to the Optic Nerve and Nasal Macular Subretinal Fluid (Pic)

Peripapillary Pachychoroid Syndrome (PPS) -- Maximum Choroidal Thickness Close to the Optic Nerve and Nasal Macular Subretinal Fluid (Pic)