Distribution and morphologic characteristics of choroidal vortex veins in Pachychoroid disease

Purpose: This study aimed to elucidate the distribution and morphological features of choroidal vortex veins in pachychoroid disease (PCD). Design: Retrospective observational study. Subjects: Patients with PCD included from January 2022 to June 2023. Methods: We conducted a retrospective cross-sectional analysis using wide-field indocyanine green angiography (WF-ICGA) to assess choroidal vortex veins in PCD patients, categorizing them based on location (equatorial/posterior) and morphology (absent, incomplete, complete, complete with ampulla). Main Outcome Measures: The incidence of different location and morphology of vortex veins in PCD. Results: A total of 190 eyes from 99 PCD patients were examined. Notably, only 8.9 % (17/190) of eyes had posterior vortex veins. We identified 1620 vortex veins, predominantly equatorial (99 %, 1603/1620). Morphologically, the most common type was incomplete (61.9 %), followed by complete (19.5 %), absent (11.1 %), and complete with ampulla (7.5 %). The distribution of these veins varied, with the inferotemporal quadrant showing the highest prevalence at 26.9 %, followed by the superonasal (26.1 %), superotemporal (24.3 %), and inferonasal (22.7 %) quadrants. The median number of vortex veins per eye was 8, with a range from 5 to 15. Conclusions: This study highlights that posterior vortex veins are less frequent in PCD eyes, with incomplete veins being the most prevalent. These findings provide important clinical evidence for understanding the distribution and morphologic characteristics of choroidal vortex veins in PCD, contributing to our knowledge of the pathophysiological mechanisms underlying this condition.