Pachychoroid Spectrum Diseases: Long-term Visual Outcomes, with a Focus on Risk Factors Affecting Central Serous Chorioretinopathy

Abstract Purpose: To analyze the long-term visual outcomes of pachychoroid spectrum diseases (PSD). Design: Retrospective study. Methods: We reviewed the medical charts of consecutive patients with PSD, including focal choroidal excavation (FCE), pachychoroid pigment epitheliopathy (PPE), central serous chorioretinopathy (CSC), and pachychoroid neovasculopathy (PNV). The patients visited the Tokyo University Hospital from January 2008 to April 2022. Survival analyses were performed, in which loss of vision was defined as visual acuity (VA) of 0.2 logarithm of minimal angle of resolution (logMAR) or worse, 0.5 logMAR or worse, or VA worsening by 0.3 logMAR or greater. Moreover, we further investigated factors associated with visual prognosis, particularly in the CSC group. Results: A total of 741 eyes of 638 patients were included in this analysis. The CSC or PNV group showed significantly worse visual prognosis than the FCE&PPE group for VA to 0.2 logMAR or worse (P=0.0117 or 0.0001, respectively) and for VA worsening by 0.3 logMAR or greater (P=0.0283 or 0.0037, respectively). In the CSC group, unlike age, sex, or treatment history, the duration of subfoveal fluid existence ≥12 months (continuous or intermittent) was significantly associated with visual prognosis (P<0.0001). Conclusions: Among PSD, CSC and PNV were associated with a higher risk of vision loss in the long term than FCE and PPE. The duration of subretinal fluid existence was identified as a significant factor affecting long-term visual outcomes in CSC.