Relationship between choroidal vascular hyperpermeability, choriocapillaris flow density, and choroidal thickness in eyes with pachychoroid pigment epitheliopathy

Purpose: To use swept-source optical coherence tomography and swept-source optical coherence tomography angiography to investigate potential relationships between choroi- dal vascular hyperpermeability (CVH) seen with indocyanine green angiography (ICGA), choriocapillaris flow density, and choroidal thickness in eyes with pachychoroid pigment epitheliopathy. Methods: Patients with pachychoroid pigment epitheliopathy were prospectively imaged with 12-mm · 12-mm swept-source optical coherence tomography, 12-mm · 12-mm swept-source optical coherence tomography angiographyA, and ICGA. Binarized choriocapillaris OCTA images were superimposed with ICGA images in which CVH area had been isolated. Choriocapillaris flow density within or outside the quadrants of CVH was calculated and the ratio of these two values was determined. The presence of CVH and choroidal thickness was evaluated at 9 locations within a central 3-mm · 3-mm area to explore the relationship between these 2 factors. Results: Ten eyes from 10 patients were enrolled in the present study. Choriocapillaris flow density within quadrants of CVH area was significantly lower compared with quadrants without CVH (P , 0.001). The mean choriocapillaris flow density ratio was 0.86 ± 0.10 (range: 0.65–0.99). From among the 90 locations in 10 study eyes, 48 were within areas of CVH. Choroidal thickness was greater in quadrants of CVH compared with areas without CVH (P , 0.001, 455 ± 122 mm vs. 297 ± 93 mm). Conclusion: Reduced choriocapillaris flow density, increased choroidal thickness, and CVH appear to co-localize in eyes with pachychoroid pigment epitheliopathy.