Photoreceptor damage in pachychoroid pigment epitheliopathy

Purpose: To investigate the relationship between choriocapillaris perfusion and photoreceptor integrity in pachychoroid pigment epitheliopathy (PPE). Methods: We compared 44 PPE eyes with 30 healthy controls using swept-source OCT angiography to analyse ellipsoid zone reflectivity, choriocapillaris flow deficit percentage (FD%) and retinal capillary perfusion. Results: PPE eyes showed significantly reduced EZ reflectivity compared to controls (0.73 ± 0.10 vs 0.79 ± 0.05, p = 0.014), increased choriocapillaris ischemia (CC FD%: 46.6 ± 6.3 vs 32.5 ± 2.9, p < 0.001), and reduced deep capillary plexus perfusion (33.1 ± 4.6 vs 38.6 ± 3.3, p < 0.001). Multiple regression analysis revealed a significant inverse association between increased CC ischemia and reduced EZ reflectivity (r = −0.364, p < 0.001). Conclusion: Choriocapillaris ischemia significantly correlates with photoreceptor damage in PPE, suggesting vascular dysfunction as a key pathogenic mechanism.