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Lee, Jae Hyung, MD, PhD; Kim, Jun Yong, MD; Jung, Byung Ju, MD; Lee, Won Ki, MD, PhD

doi: 10.1097/IAE.0000000000002187
Original Study: PDF Only

Purpose: To describe a distinctive focal disruption of the ellipsoid zone (EZ)/interdigitation zone (IZ) determined by spectral-domain optical coherence tomography in eyes with pachychoroid pigment epitheliopathy.

Methods: Twenty patients with focal EZ/IZ disruptions associated with pachychoroid without history or findings indicative of subretinal fluid were evaluated. Detailed clinical/imaging characteristics and their longitudinal changes were evaluated.

Results: A total of 27 lesions from 21 eyes were included. The mean subfoveal choroidal thickness was 450 μm. In six of seven eyes with previous imaging data to compare, characteristic drusenoid lesions associated with thick choroid preceded focal EZ/IZ disruptions at the corresponding sites. Dilated outer choroidal vessels were noted beneath the focal EZ/IZ disruption in 24 lesions (88.9%), with attenuation of choriocapillaris in 18 lesions (66.7%). The external limiting membrane was intact in all lesions. All except three eyes did not show morphologic changes, and mean visual acuity was maintained (Snellen equivalent, 20/25) during a mean follow-up period of 20 months.

Conclusion: Focal disruptions of the EZ/IZ band can develop in pachychoroid eyes in the absence of subretinal fluid, with a stable clinical course, and possibly as a result of regression of drusenoid lesions. This may represent an atrophic form of pachychoroid manifestation.

Focal disruptions of the ellipsoid zone/interdigitation zone band can develop in pachychoroid eyes, and after the regression of drusenoid lesions in some cases. These lesions showed a stable clinical course unlike soft drusen–associated atrophy.

Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Reprint requests: Won Ki Lee, MD, PhD, Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-ku, Seoul 137-701, Korea; e-mail:

Paper presented as “Outer Retinal Changes in Pachychoroid Pigment Epitheliopathy” at the Fifth Annual International Retinal Imaging Symposium (IRIS V) held in the Ronald Reagan UCLA Medical Center, Los Angeles, CA, March 25, 2017.

W. K. Lee has served on advisory boards for Novartis Bayer, Allergan, Alcon, and Santen, and has received consultancy fees from these companies. He has received payments for lectures from Novartis, Bayer, Allergan, and Alcon. The remaining authors have no financial/conflicting interests to disclose.

© 2019 by Ophthalmic Communications Society, Inc.