Clinical Characteristics and Progression of Pachychoroid Macular Atrophy in Central Serous Chorioretinopathy

Purpose: Macular atrophy (MA) is a late-stage complication often associated with age-related macular degeneration (AMD). However, it can also occur in pachychoroid diseases, including central serous chorioretinopathy (CSCR), called pachychoroid MA (pMA). This study aimed to investigate the characteristics and progression of pMA in CSCR. Design: Multicenter retrospective study as part of the Macula Society International CSCR Research Network (MICRoN). Participants: Thirty-eight eyes of 32 patients. Methods: Demographic and imaging data were collected. Optical coherence tomography and fundus autofluorescence images were analyzed to identify pMA features, including complete retinal pigment epithelium and outer retinal atrophy, pachychoroid phenotype, and baseline CSCR characteristics. The study comprised 2 parts: (1) progression analysis, comparing time to pMA among OCT features in cases without baseline pMA; and (2) follow-up analysis, including patients with at least a 12-month interval between 2 visits showing pMA progression. Pachychoroid macular atrophy area, number, and location were manually measured using the HEYEX-2 platform and ImageJ. Main Outcome Measures: Progression analysis: OCT features that contributed to faster development of pMA. Follow-up analysis: progression rate of pMA after square root transformation (SQRT) and features that contribute to faster progression in lesion size. Results: Among 1675 eyes with CSCR, the prevalence of pMA was 2.27% and the incidence of pMA was 0.89%. Eyes with intraretinal fluid (IRF) experienced faster time to development of pMA (31.34 ± 16.66 months) compared with those without IRF (64.13 ± 37.14 months, P = 0.039). The mean pMA area increased from 1.65 ± 2.09 mm² to 3.08 ± 3.14 mm², with a mean progression rate of 0.29 ± 0.28 mm²/year. Central pMA exhibited a faster progression rate than noncentral pMA (0.13 ± 0.078 mm²/year vs. 0.052 ± 0.055 mm²/year, P = 0.011). Larger baseline pMA area was significantly associated with quicker progression (r = 0.65, P ≤ 0.001). However, after SQRT of pMA area, no significant association with baseline area was found. There was significant reduction of central macular thickness (195.72 ± 96.58 to 153.64 ± 100.25 microns, P = 0.034) and subfoveal choroidal thickness (372.92 ± 83.84 to 342.8 ± 78.33 microns, P value = 0.029) at follow-up. Conclusions: Pachychoroid MA in CSCR exhibits distinct characteristics compared with AMD-related geographic atrophy from established literature. It progresses at a slower rate, and larger lesions tend to advance more rapidly. Additionally, central pMA progresses faster than noncentral pMA. The presence of IRF during the disease course accelerates the progression of CSCR to pMA. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.