What question did this study set out to answer?

The study aims to evaluate long-term changes in retinal pigment epithelium lesions in pachychoroid pigment epitheliopathy and identify predictors for disease evolution.

March 28, 2026Open Access

Pachychoroid pigment epitheliopathy: long-term structural changes and risk factors for disease evolution

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The study aims to evaluate long-term changes in retinal pigment epithelium lesions in pachychoroid pigment epitheliopathy and identify predictors for disease evolution.
Conducted a retrospective cohort study with 45 patients diagnosed with pachychoroid pigment epitheliopathy.
Utilized multimodal imaging techniques, including optical coherence tomography and near-infrared reflectance.
Measured total retinal pigment epithelium lesion area and choroidal thickness at baseline and after 1 year.
Applied multivariable regression to identify baseline predictors of lesion progression.
Total retinal pigment epithelium lesion area increased significantly after 1 year.
Central subfield thickness and central choroidal thickness showed no significant changes over time.
Greater baseline choroidal thickness was linked to increased lesion progression, while smaller initial RPE areas indicated a higher rate of increase.

Resumen

Abstract Purpose Pachychoroid pigment epitheliopathy (PPE) is an early, often asymptomatic stage of the pachychoroid disease spectrum that may progress to central serous chorioretinopathy (CSC), pachychoroid neovasculopathy, or polypoidal choroidal vasculopathy. This study evaluated longitudinal changes in retinal pigment epithelium (RPE) lesions in PPE and identified baseline predictors. Design Retrospective cohort study. Participants Forty-five eyes (45 patients) with PPE. Methods All patients underwent multimodal imaging, including near-infrared reflectance, optical coherence tomography (OCT), blue fundus autofluorescence, and OCT angiography. RPE alteration areas were quantified by projecting OCT B-scan delineations onto near-infrared images. Central subfield thickness (CST) and central choroidal thickness (CCT) were measured, along with choroidal thickness at four quadrants 500 µm and 1000 µm from the foveal centre. Main outcome measures Change in total RPE lesion area at 1-year follow-up and baseline predictors of lesion progression. Results At 1 year, total RPE lesion area increased significantly (median 0.81 mm² vs. 0.71 mm² at baseline; p < 0.001), with a median percentage increase of 10.5%. The number of discrete lesions remained unchanged. CST and CCT showed no significant longitudinal changes. Preliminary 2-year data ( n = 13) demonstrated similar trends. Multivariable regression identified greater baseline CCT as independently associated with increased RPE lesion progression, whereas smaller baseline RPE areas were associated with a greater relative increase. Conclusions PPE demonstrates progressive RPE alterations over time despite stable retinal and choroidal thickness. Greater baseline choroidal thickness and limited initial RPE involvement predict faster lesion expansion, supporting PPE as an active and evolving condition requiring regular multimodal monitoring.

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