Karakosta Christina, Kiraly Peter, Bisoukis Anastasios, Bougioukas Konstantinos I, Fischer M Dominik
Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Ophthalmol Ther. 2025 Sep 1. doi: 10.1007/s40123-025-01226-8.
This study investigated the long-term natural history of peripapillary pachychoroid syndrome (PPS), analyzing both morphological and functional outcomes.
This retrospective study included 24 eyes from 14 participants diagnosed with PPS. No interventions were administered. Baseline and follow-up assessments comprised best-corrected visual acuity (BCVA), measured on the LogMAR scale, inner nasal (IN) and outer nasal (ON) macular thickness measured using the ETDRS (Early Treatment Diabetic Retinopathy Study) subfields. To account for repeated measures and the hierarchical structure of eyes nested within participants, and to appropriately handle incomplete longitudinal data, linear mixed-effects models were utilized for all statistical analyses.
The mean age was 74 ± 7 years, and 71% of patients had bilateral PPS. All patients had peripapillary atrophy at baseline. The mean baseline BCVA was 0.05 and showed only small variations over time. ON macular thickness showed a significant decrease at 2 years (Δ = - 36.9 µm, p = 0.034), whereas IN macular thickness decreased significantly at both 2 years (Δ = - 40.75 µm, p = 0.023) and 3 years (Δ = - 39.97 µm, p = 0.042). One-quarter of participants developed a serous pigment epithelium detachment with subretinal fluid, suggesting an overlapping PPS/CSC (central serous chorioretinopathy) phenotype.
Peripapillary atrophy appears to be an important anatomical predisposition for PPS. Waxing and waning of intraretinal fluid were observed during the natural course of PPS, with a significant reduction at 2 years. Most patients remained asymptomatic and maintained stable BCVA throughout long-term follow-up, indicating a generally favorable prognosis in the absence of intervention.
本研究调查了视盘周围厚脉络膜综合征（PPS）的长期自然病程，分析了形态学和功能学结果。
这项回顾性研究纳入了14名被诊断为PPS的参与者的24只眼睛。未进行任何干预。基线和随访评估包括使用LogMAR视力表测量的最佳矫正视力（BCVA），以及使用糖尿病视网膜病变早期治疗研究（ETDRS）子区域测量的鼻侧内（IN）和鼻侧外（ON）黄斑厚度。为了考虑重复测量以及参与者内眼睛的层次结构，并适当处理不完整的纵向数据，所有统计分析均使用线性混合效应模型。
平均年龄为74±7岁，71%的患者患有双侧PPS。所有患者在基线时均有视盘周围萎缩。平均基线BCVA为0.05，且随时间仅有微小变化。ON黄斑厚度在2年时显著降低（Δ=-36.9 µm，p=0.034），而IN黄斑厚度在2年（Δ=-40.75 µm，p=0.023）和3年（Δ=-39.97 µm，p=0.042）时均显著降低。四分之一的参与者出现了伴有视网膜下液的浆液性色素上皮脱离，提示PPS/中心性浆液性脉络膜视网膜病变（CSC）重叠表型。
视盘周围萎缩似乎是PPS的一个重要解剖学易患因素。在PPS的自然病程中观察到视网膜内液的消长，在2年时显著减少。大多数患者在长期随访中保持无症状且BCVA稳定，表明在无干预的情况下总体预后良好。
