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Features of Pachy-Reticular Pseudodrusen
TAKE-HOME MESSAGE
- This observational, retrospective study evaluated the features of the association between reticular pseudodrusen (RPD) and pachychoroid (pachy-RPD) in comparison with those of RPD and normal/leptochoroid. Eyes with pachy-RPD showed a different distribution of RPD stages compared with eyes with RPD with normal/leptochoroid. Notably, eyes with pachy-RPD showed greater choroidal perfusion.
- These findings provide clinically useful information on pachychoroid and RPD distribution.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
To characterize the features of a peculiar association between reticular pseudodrusen (RPD) and pachychoroid (pachy-RPD) and to compare them with eyes affected by RPD and normal/leptochoroid.
DESIGN
Observational, retrospective, case-control study.
PARTICIPANTS
Among a cohort of patients with intermediate age-related macular degeneration (AMD), we selected eyes with RPD and pachychoroid (i.e., choroidal thickness of >50 μm). A control group of RPD eyes but without pachychoroid (i.e., a choroidal thickness of <250 μm) was included.
METHODS
Number and stages of RPD were evaluated in each ETDRS subfield. Furthermore, choroidal perfusion was investigated using the choroidal vascularity index (CVI), and choriocapillaris perfusion density (PD) on structural OCT and OCT angiography.
MAIN OUTCOME MEASURES
Description of the multimodal imaging features of pachy-RPD and differences with RPD associated with normal/leptochoroid.
RESULTS
Among 111 RPD eyes, 37 were included in the pachy-RPD group and 74 in the control group. Patients with pachy-RPD were significantly younger than patients with RPD and normal/leptochoroid (mean age, 75 ± 16 and 82 ± 7 years, respectively; P = 0.002). Total RPD number was comparable between the 2 groups (P = 0.220). However, pachy-RPD eyes showed a significantly higher number of stage 1 RPD in comparison to the controls (P < 0.001), and a lower number of stage 3 (P < 0.001) and stage 4 RPD (P = 0.052). The CVI and choriocapillaris PD were greater in pachy-RPD than in the control group (P < 0.001 and P= 0.010, respectively).
CONCLUSIONS
Pachy-RPD are characterized by a different distribution of RPD stages (i.e., more early stages and fewer advanced stages) in comparison to RPD with normal/leptochoroid. Furthermore, pachy-RPD eyes showed greater perfusion indices of the choroid. These features suggest that the presence of pachychoroid could be a protective factor in the RPD evolution to the advanced AMD forms.
Additional Info
Pachy-Reticular Pseudodrusen
Ophthalmol Retina 2024 Nov 01;8(11)1066-1073, R Sacconi, G Fazzari, V Capuano, M Menean, F Beretta, K El Matri, F Bandello, E Souied, G QuerquesFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Sacconi and co-authors reported the results from an observational, retrospective, case–control study, uniquely revealing the features of a peculiar association between reticular pseudodrusen (RPD) and choroidal thickness in patients with intermediate age-related macular degeneration (iAMD). It has been demonstrated that RPD is located in the apical domain of retinal pigment epithelium layers, whereas its composition shares major markers of sub–retinal pigment epithelial soft drusen, implying that RPD and soft drusen may undergo different but unifiable pathways toward age-related macular degeneration. In the study of drusen development, choriocapillaris flow deficits have been identified as a risk factor for the progression of iAMD. The next question is how RPD formation and choroidal blood flow are related, which was explored in this study.
The study results showed that increased thickness of the choroid, an indicator of adequate choroidal blood flow, was correlated with a mild form of RPD. This finding supports the idea that adequate choroidal blood flow is a protective factor against RPD progression. Thus, the current work may contribute a valuable therapeutic idea to minimize RPD progression and delay iAMD development via modification of choroidal blood flow.
Unfortunately, an editorial error was found in the abstract section of this important work. The pachychoroid — that is, the thick choroid — should be defined as a choroidal thickness of >250 µm; however, it was mistakenly typed as >50 µm. This typographical error may confuse the readers regarding the definition of a thickened choroid. Therefore, a correction to the choroidal thickness may be published in the coming journal erratum.