Evaluation of anterior scleral thickness in pachychoroid pigment epitheliopathy, central serous chorioretinopathy and pachychoroid neovasculopathy

To compare anterior scleral thickness (AST) among pachychoroid pigment epitheliopathy (PPE), central serous chorioretinopathy (CSC), pachychoroid neovasculopathy (PNV) and healthy controls.

Retrospective cross-sectional study.

This single-center, retrospective cross-sectional study included 73 eyes of 72 patients with pachychoroid spectrum disease (PPE (n = 35), CSC (n = 25), PNV (n = 12)) and 29 control eyes. All participants underwent comprehensive ophthalmic examination and swept-source optic coherence tomography (OCT) (Topcon DRI-OCT Triton). Choroidal thickness (CT) was measured subfoveally, at 500 and 1000 μm nasal/temporal to the fovea, and sublesionally. AST was measured with the anterior segment mode 6 mm posterior to the scleral spur in four quadrants.

CT was significantly greater in CSC than in PPE, PNV, and controls at all macular locations (all p < 0.001). Sublesional CT differed among pachychoroid groups (p = 0.005), with CSC thicker than PPE (p = 0.002) and PNV (p = 0.011); PPE and PNV did not differ (p = 1.000). Anterior scleral thickness was significantly greater in all quadrants in the pachychoroid groups compared with controls (p < 0.001). Superior AST was greater in PPE than PNV (p = 0.044); other inter-pachychoroid comparisons were not significant (p > 0.05). In multivariate linear regression model, the presence of pachychoroid spectrum disease was independently associated with thicker AST after adjustment for age, sex, AXL, and SE (p< 0.001 for all quadrants).

Eyes with pachychoroid spectrum disease exhibit increased AST relative to controls, while diffuse CT thickening is most pronounced in CSC. These findings support a pathophysiologic association between scleral structure and choroidal venous overload in pachychoroid disorders and highlight AST as a potential structural biomarker.