Search Results (137)

Background/Objectives: To evaluate macular structural changes after uncomplicated phacoemulsification using optical coherence tomography (OCT) and to investigate whether cardiometabolic disease influences the early postoperative retinal response. Methods: This retrospective observational study included 111 eyes from 111 patients undergoing uncomplicated phacoemulsification with intraocular lens implantation. Macular OCT parameters were evaluated preoperatively and at postoperative days 1, 7, and 30. Patients were stratified according to the presence of cardiometabolic disease, and retinal changes were compared between groups. Results: Exploratory visit-specific comparisons produced nominal differences in average retinal thickness and macular volume at several assessments; however, none remained statistically significant after Holm adjustment across the 16 parameter-by-visit comparisons. The adjusted models provided no statistically significant evidence that postoperative changes from baseline differed according to cardiometabolic status. Model-derived interaction contrasts at days 1, 7, and 30 were small and their 95% confidence intervals included zero for all OCT outcomes. Accordingly, no statistically significant differences in postoperative change from baseline were detected between groups; equivalence was not assessed. Conclusions: Although nominal differences were observed in exploratory visit-specific comparisons, none remained statistically significant after multiplicity adjustment. Furthermore, the adjusted analyses did not detect statistically significant differences in postoperative change from baseline according to cardiometabolic status after adjustment for baseline retinal structure and relevant demographic and surgical confounders. No statistically significant evidence of different postoperative OCT trajectories was detected between groups; equivalence was not assessed. Full article

Background: Optical coherence tomography (OCT) and OCT angiography (OCTA) retinal imaging in inherited retinal dystrophies (IRD) has been limited to the posterior pole and central midperiphery (up to about 16.5 × 16.5 mm). Two novel commercially available swept-source (SS) OCT/-OCTA devices provide the possibility of wide-field (WF) evaluation of retinal and choroidal structures, including the vasculature, in a single examination. Methods: A limited consecutive series of 16 IRD patients were examined with a BMizar (400 kHz, 24 × 20 mm scan width) and a Dream OCT (200 kHz, 26 × 21 mm scan width) in addition to the normal clinical examination protocol. This series included patients with retinitis pigmentosa, cone-rod dystrophy, macular dystrophy and autosomal recessive bestrophinopathy. In addition, 12 healthy probands were examined. Results: WF-SS-OCT/-OCTA enabled the detection of retinal, choroidal and choriocapillaris alterations in the macular and midperiphery in a short, single examination session of up to 15 s. Even small foveal lesions and a small silent macular neovascularization were detected on WF screening. Regional alterations of choroidal and choriocapillaris flow patterns were identified. These were mostly in correspondence with areas that appeared clinically affected, but unexpected lesions were identified as well. Occlusion of peripheral retinal vessels was seen in retinitis pigmentosa, though flow was detected in retinal vessels, which were difficult to distinguish on fundus images. In one patient with nystagmus, WF-SS-OCT/-OCTA was performed, whereas standard OCT volume scan could not be obtained. The most frequent artifact were horizontal lines of misalignment, which did not interfere with the detection of pathologies. Conclusions: Both WF-SS-OCT/-OCTA devices provide detailed insights in structural and vascular retinal and choroidal alterations in a single, short examination. Larger series of IRD patients examined with WF-SS-OCT/-OCTA promise to provide novel insights into the pathology of IRDs. Full article

Background/Objectives: To evaluate whether the combination of oral eplerenone and half-dose full-fluence photodynamic therapy (HD-FF PDT) provides greater efficacy than HD-FF PDT alone in persistent central serous chorioretinopathy (CSCR). Methods: This monocentric, retrospective, observational study included patients with persistent (>6 months) simple or complex CSCR who had previously undergone either half-dose full-fluence photodynamic therapy (HD-FF PDT) alone or HD-FF PDT combined with oral eplerenone as part of routine clinical practice between September 2024 and March 2025. Functional and morphological data collected at baseline and at 1, 3, and 6 months after treatment were retrospectively reviewed. An artificial intelligence–based algorithm was used to analyze OCT scans, quantifying subretinal and intraretinal fluid volumes (SRFV, IRFV) and assessing ellipsoid zone and external limiting membrane integrity, hyperreflective foci, subfoveal choroidal thickness (SCT), and central macular thickness (CMT). Results: Fifty patients (53 eyes; mean age 52 years) were included, with no significant baseline differences between groups. Best-corrected visual acuity improved more significantly in Group B at 1 and 6 months (p = 0.032 and p = 0.009, respectively). At 6 months, subretinal fluid volume (SRFV), quantified by AI-based OCT analysis, was significantly lower in the combined therapy group (p = 0.014). An AI-defined complete resolution of subretinal fluid (SRFV < 0.010 mm³) was achieved more frequently in Group B than in Group A (77% vs. 22%, p = 0.001). Conclusions: Although HD-FF PDT remains the standard treatment for persistent CSCR, adjunctive therapy with the mineralocorticoid receptor antagonist eplerenone may enhance subretinal fluid reabsorption and improve mid-term anatomical and functional outcomes. Full article

Background: Faricimab is one of the most potent anti-vascular endothelial growth factors used in the management of diabetic macular edema (DME). However, real-world benefits regarding its timing and efficacy are still being explored. Methods: This retrospective non-randomized pilot study aimed to evaluate the efficacy of intravitreal faricimab in the treatment of DME. Eyes initially treatment-naïve for DME with a follow-up of 1 year were grouped as: group 1, where faricimab was introduced within the first six months after the start of treatment; group 2, where it was initiated six or more months after treatment with other drugs. Study parameters included changes in best corrected visual acuity (BCVA) and optical coherence tomography based structural parameters within the 6 × 6 mm optical coherence tomography (OCT) scan regions. Results: Forty-two eyes from 26 patients were analyzed. No statistically significant differences were observed between the groups in cluster-weighted proportions of intra- or sub-retinal fluid, retinal thickness or volume parameters, although group 1 showed modest numerical benefits. SRF showed a trend towards qualitative reduction in group 1, although IRF showed persistence in both groups. Adjusted linear mixed-effects modeling demonstrated no significant impact of early faricimab initiation on functional and anatomical outcomes, which appeared to be influenced by the baseline BCVA, glycemic control, and the number of injections, nullifying the benefits. Conclusions: Faricimab demonstrated modest anatomical improvements with earlier treatment in eyes initially treatment-naïve for DME. Further prospective studies are indicated to assess the treatment strategy and the timing of introduction with faricimab in such eyes. Full article

Background and Objectives: Despite recent advancement, neovascular age-related macular degeneration (nAMD) remains a leading cause of irreversible vision loss. Undertreatment, fewer anti-VEGF injections and longer intervals than in clinical trials have been associated with sub-optimal visual outcomes. Visit-based regimens (Treat-and-Extend, PRN) may permit intervals of unrecognized retinal fluid between office visits. A home OCT system with near-daily self-imaging provides frequent structural retinal information between office visits that can support early detection of persistent or recurring fluid. The objective was to evaluate the duration and magnitude of fluid exposure between standard care visits and estimate the potential to shorten that exposure. Materials andMethods: Ad hoc analysis of three cohorts of treatment naïve and experienced nAMD eyes managed by standard care while participating in observational studies of the home OCT system, with treating physicians masked to home OCT data. AI-based analysis of fluid volume, rate of change and time of fluid onset was performed. Results: Data from 209 participants, mean age 76.4 years, 53% female, who performed 10,110 scans (6.0 scans/week) were analyzed. An amount of 119 eligible eyes provided data from 185 standard care intervals. Persistent or recurring fluid was identified in 121 (65%) intervals, on average 32 days prior to the next office visit. Of these, 84 (69%) had potential visit advancement within labeled minimal treatment intervals of 19 days. Mean fluid volume at the earliest possible notification was 26 nL and recurrence rate averaged 4.4 nL/day. Conclusions: A substantial proportion of patients experience unrecognized disease activity between visits. Home OCT monitoring provides adjunctive information to support early detection of fluid and may facilitate timely clinical evaluation. In this context, such monitoring may be considered reasonable and necessary to inform management of nAMD within established standards of care, while not replacing clinician-directed diagnosis or treatment decisions. Full article

Background/Objectives: To explore potential associations between pediatric obesity and retinal and anterior segment ocular structures using OCT and ocular biometry. This study was designed as an exploratory, hypothesis-generating analysis without a pre-specified primary endpoint; all findings should be interpreted accordingly. Methods: This retrospective cross-sectional study included 52 children (104 eyes): 27 obese children (body mass index (BMI) percentile ≥95%) and 25 healthy controls (BMI percentile 5–85%). Optical coherence tomography (OCT) and ocular biometry were used to assess retinal nerve fiber layer (RNFL), ganglion cell complex (GCC), focal loss volume (FLV), global loss volume (GLV), Early Treatment Macular Map 5 (EMM5), corneal parameters, axial length (AL), anterior chamber depth (ACD), and white-to-white corneal diameter (WTOW). Group comparisons and cluster-robust bootstrap regression adjusted for inter-eye dependency, age, and sex; Bonferroni correction was applied. Results: Obese children showed nominally higher GCC average thickness, RNFL, and EMM5 values and shallower ACD; however, no parameter survived Bonferroni correction. ACD showed the most internally consistent exploratory pattern (unadjusted p = 0.006; adjusted p = 0.018; Bonferroni p = 0.249); however, this finding did not survive Bonferroni correction and should not be interpreted as a confirmed association. Other corneal and biometric parameters were not significantly different. Conclusions: Pediatric obesity may be associated with subtle ocular structural variations, but all findings are exploratory and hypothesis-generating. Larger prospective, pre-registered studies are needed to determine whether pediatric obesity is associated with structural ocular changes. Full article

Macular pigment optical density (MPOD) is widely measured by dual-wavelength autofluorescence imaging (AFI) because the method is noninvasive, image-based, and clinically practical. AFI-derived MPOD and macular pigment optical volume (MPOV) are increasingly used as retinal biomarkers in clinical research, supplementation studies, disease-risk interpretation, and population-based comparisons. However, conventional dual-wavelength AFI assumes that posterior absorbers other than macular pigment (MP), particularly melanin, are negligible or sufficiently stable not to bias the measurement. This assumption may limit the diagnostic and biomarker reliability of AFI-derived MP metrics. This manuscript presents a focused biological, optical, and mathematical analysis of AFI-based MP quantification. The foundational AFI literature, the melanin imaging literature, retinal pigment epithelium (RPE) pigment biology, and related optical modeling concepts were examined to evaluate where melanin enters the AFI signal pathway, how it may confound MPOD and MPOV, and how a melanin-sensitive baseline could improve quantitative specificity within the AFI domain. Conventional dual-wavelength AFI estimates MP indirectly from attenuation of RPE lipofuscin autofluorescence under excitation wavelengths that differ in MP absorption. Because melanin is located in the RPE and choroid, varies with retinal location, age, and pigmentation, and can influence the same excitation and detection pathway, unmeasured melanin can become embedded in the apparent MPOD signal. Under these conditions, reported MPOD and derived MPOV are better understood as model-dependent estimates whose quantitative specificity may vary across subjects, retinal locations, devices, and studies. This has direct implications for diagnostic interpretation, normative databases, cross-subject comparison, supplementation-response studies, and biomarker-based retinal assessment. Melanin correction is not a minor refinement of AFI-based MP quantification. It is likely necessary when AFI-derived MP metrics are intended to be interpreted as quantitatively specific retinal biomarkers rather than conditionally approximate optical estimates. A melanin-corrected AFI framework, based on introducing a melanin-sensitive baseline wavelength outside the principal MP absorption range, offers a path toward more reliable MPOD and MPOV interpretation in clinical, diagnostic, and supplementation-related studies. Full article

Purpose: To evaluate the anatomical and functional efficacy of photobiomodulation (PBM) therapy in patients with dry age-related macular degeneration (AMD) and to investigate structural predictors of visual response. Methods: This retrospective study included 47 eyes of 30 patients with dry AMD treated with PBM. Best-corrected visual acuity (BCVA) was recorded as Early Treatment Diabetic Retinopathy Study (ETDRS) letter score, and visual change (ΔBCVA) was calculated. Spectral-domain optical coherence tomography parameters—central retinal thickness (CRT), central macular volume (ETDRS 9-subfield central zone), and photoreceptor layer integrity (external limiting membrane [ELM], ellipsoid zone [EZ], and interdigitation zone [IZ])—were assessed pre- and post-treatment. Age-Related Eye Disease Study (AREDS) stage was graded per eye. Because both eyes from some patients were included, generalized estimating equation (GEE) models with patient-level clustering were used to account for inter-eye correlation. Effect estimates were reported as unstandardized coefficients with 95% confidence intervals. Results: Visual acuity improved following PBM therapy, with mean ETDRS letter scores increasing from 75.0 ± 14.1 to 78.0 ± 12.1 letters. In the GEE model accounting for patient-level clustering, the estimated mean gain was 2.97 ETDRS letters (95% CI: 1.15 to 4.79; p = 0.001). Mean CRT showed no significant change following PBM therapy (210.32 ± 48.61 µm vs. 211.23 ± 50.27 µm; GEE estimate: +0.91 µm; 95% CI: −5.52 to 7.35; p = 0.780). Central macular volume likewise remained stable (0.1913 ± 0.030 vs. 0.1919 ± 0.033 mm³; GEE estimate: +0.0006 mm³; 95% CI: −0.0054 to 0.0067; p = 0.836). Photoreceptor layer integrity demonstrated limited structural change, with no significant time effect for EZ or IZ integrity in binary GEE models and no observed pre–post change in ELM integrity. In multivariable GEE analysis, baseline BCVA (p < 0.001), ELM integrity (p < 0.001) and central macular volume (p = 0.041) were associated with change in ETDRS letter score, whereas AREDS category, EZ integrity, and IZ integrity were not. Conclusions: PBM therapy demonstrated limited short-term anatomical change but variable functional outcomes in dry AMD. Baseline BCVA emerged as the primary determinant of visual response, suggesting that treatment benefit may be influenced predominantly by pre-treatment functional reserve. Full article

Background/Objectives: Retinal vein occlusion (RVO) commonly causes vision loss from macular edema (ME). OCT biomarkers (IRF, SRF, HRF, and ELM/EZ disruption) inform prognosis and treatment but are rarely quantified routinely due to time burden and interobserver variability. We aimed to validate a deep-learning algorithm for automated detection and quantification of key OCT biomarkers in RVO-ME versus expert assessment. Methods: In this retrospective single-center study, 93 eyes with RVO-ME imaged with spectral-domain OCT were analyzed. The AI quantified IRF/SRF volumes, ELM/EZ interruption, and HRF counts. Two masked expert clinicians provided reference evaluations. Performance and agreement were assessed using ROC AUC, Cohen’s kappa, intraclass correlation coefficient (ICC), Pearson correlation, and Bland–Altman analysis. Image-quality metrics (foveal centration and retinal layer segmentation) were recorded. Results: The AI showed high diagnostic performance (AUC: SRF 0.969; ELM 0.871; EZ 0.958) and substantial-to-almost-perfect agreement (kappa: SRF 0.807; ELM 0.788; EZ 0.914). HRF quantification correlated strongly with experts (r = 0.89, p < 0.001), with very good agreement (ICC = 0.87) and minimal bias. Image-quality accuracy exceeded 98% for foveal centration and layer segmentation. Conclusions: This AI software enables reliable, rapid automated assessment of major OCT biomarkers in RVO-ME, supporting streamlined personalized management; prospective studies should confirm longitudinal monitoring and treatment-guidance value. Full article

Purpose: To determine the optimal treatment sequence for combination therapy using intravitreal faricimab (IVF) and direct photocoagulation (PC) in eyes with non-center-involved diabetic macular edema (DME). Methods: This retrospective study included 35 eyes with focal DME treated with IVF and PC targeting microaneurysms (MAs). Treatment success was defined as resolution of focal edema, indicated by disappearance of the white area (WA) on optical coherence tomography. Eyes were assigned to a PC-IVF group (initial PC followed by IVF if edema persisted after 2 months; n = 20) or an IVF-PC group (initial IVF followed by PC for residual edema; n = 15). Additional PC was performed every 2 months as needed. Results: Cumulative success rates at 2, 4, and 6 months were 35.0%, 70.0%, and 90.0% in the PC-IVF group and 60.0%, 93.3%, and 100% in the IVF-PC group, respectively. Macular volume significantly decreased at all time points in the IVF-PC group (all p < 0.01), whereas a significant reduction was observed only after 6 months in the PC-IVF group (p < 0.01). The number of MAs and the extent of edema were significantly reduced after 2 months in both groups, with greater reductions in the IVF-PC group (p < 0.05). The number of laser shots required for initial PC was significantly lower in the IVF-PC group (p < 0.0001), and the mean number of PC sessions was also reduced (0.6 vs. 1.8). In the PC-IVF group, baseline edema size was significantly smaller in successfully treated eyes (p < 0.001). Conclusions: Initiating treatment with IVF prior to PC may be advantageous in focal DME, particularly in eyes with larger edema, enabling faster anatomical improvement and reducing the need for laser treatment. Direct PC alone may be sufficient for small focal lesions with limited edema, supporting an individualized treatment strategy. Full article

This case report documents the multi-season development of a 38-year-old elite F12 shot putter with macular degeneration (<10% functional vision) who improved from 13.00 m to a personal best of 14.41 m between 2021 and 2023. Athletes classified as F11–F13 compete with significant visual impairment that limits spatial feedback during rotational tasks, yet longitudinal evidence describing integrated training frameworks remains scarce. A 12-month macrocycle integrated phase-dependent velocity-based resistance training using mean concentric velocity targets (0.70–1.00 m·s⁻¹) monitored via linear position transducers with a 10% velocity loss threshold, combined with structured auditory and tactile cueing, including metronome pacing and environmental anchors. High-volume warm-ups and prehabilitation addressed a prior L4–L5 disk herniation. The athlete achieved 14.41 m at the 2023 U.S. Para Athletics Trials, with TrackMan^®-verified release velocity of 11.3 m·s⁻¹. Bench throw velocity improved by 35.4% (0.65 to 0.88 m·s⁻¹) and squat jump velocity improved by 22.9% (1.18 to 1.45 m·s⁻¹), while post-session RPE remained manageable, indicating improved neuromuscular readiness and training tolerance. No lumbar symptom recurrence occurred. This case illustrates that integrating velocity autoregulation, multisensory stabilization, and injury-informed preparation can support meaningful performance gains in visually impaired throwers and offers an applied framework for coaches working with F11–F13 athletes. Full article

Objectives: To assess the association of structural biomarkers derived from optical coherence tomography (OCT) and choriocapillaris (CC) flow information with point-wise retinal sensitivity (PWS) measured by microperimetry (MP) in intermediate age-related macular degeneration (iAMD). Methods: Patients with iAMD received imaging with spectral-domain (SD)-OCT (Spectralis, Heidelberg Engineering) and OCT-angiography (OCT-A) (PLEX Elite 9000, ZEISS). In addition, MP examinations in photopic setting (MP-3, NIDEK) and mesopic background illumination (MAIA2, ICare) were performed. The thickness of the ellipsoid-zone (EZ) and the outer nuclear layer (ONL), as well as the volume of drusen and HRF, were segmented using deep-learning (DL)-based approaches. CC flow deficit percentage (FD%) was extracted from OCT-A slabs using a novel binarization method. Semiautomatic co-registration of MP examinations, OCT-A slabs, and OCT volumes was performed. Three exploratory models were calculated using multivariable mixed-effects models: (1) structure–function (SF) using structural OCT biomarkers, (2) flow–function (FF) utilizing OCT-A derived flow information, and (3) structure–flow–function (SFF) incorporating both OCT and OCT-A data. Model performance was evaluated using AIC and BIC criterion. Results: 19 eyes of 19 patients were evaluated, totalling 3297 MP-stimuli, 1873 B-scans, and 19 OCT-A slabs. Mean (SD) age was 76 (7) years, and sensitivity was 26.0 (3.36) dB in the MP-3 and 22.42 (3.64) dB in the MAIA2. Mesopic MAIA2 examinations showed significantly lower PWS values (−3.56 to −3.63 dB; p < 0.001). Drusen and HRF volume decreased PWS (−0.6 [95% CI: −1.04; −0.16] dB/nL; p = 0.007 and −9.56 [95% CI: −12.86; −6.26] dB/nL; p < 0.001), while ONL was positively associated with PWS (0.06 [0.05; 0.07] at an eccentricity of 5.2°; p < 0.001) in the SF model. CC FD% was not significantly associated with PWS in the FF and the SFF model (p > 0.05 in both cases). In the SFF model drusen volume (−1.69 [95% CI: −2.09; −1.29] dB/nL; p < 0.001), EZ (0.04 [95% CI: 0.02; 0.06] dB/µm; p < 0.001), and ONL thickness (0.03 [95% CI: 0.02; 0.04] dB/µm; p < 0.001) were significant predictors for PWS. The SF model exhibited the lowest AIC and BIC indicating best model performance. Conclusions: Structural parameters derived from SD-OCT such as HRF, drusen volume, and outer retinal layer thickness may be more closely associated with PWS, with CC FD% as an OCT-A-derived metric contributing limited additional explanatory benefit in cross-sectional analyses. Full article

Introduction: Although anterior non-infectious uveitis affects the structures of the anterior segment of the eye, (inflammatory) disruption of the hemato–ocular barrier may lead to changes in the structures of the posterior segment of the eye. Objective: To evaluate functional retinal changes using multifocal electroretinography (mfERG) and their relationship with structural optical coherence tomography (OCT) parameters in patients with acute anterior non-infectious uveitis (AANU). Methods: This prospective study included 38 eyes of 19 patients diagnosed with unilateral AANU and age-matched healthy fellow eyes as controls. All subjects underwent comprehensive ophthalmological examination, including best-corrected visual acuity (BCVA), spectral-domain OCT, and mfERG testing at baseline, 3 months, and 6 months. mfERG parameters (amplitude and implicit times) were analyzed alongside central field thickness (CFT), macular volume (MV), and average macular thickness (AMT). Results: Eyes affected by AANU demonstrated a significant reduction in mfERG response amplitude in the central retinal region compared with control eyes, particularly during the acute phase. Although OCT parameters showed partial structural normalization during follow-up, functional recovery was less pronounced in selected retinal regions. Latency values showed minimal variation over time. These findings indicate a potential dissociation between electrophysiological function and structural morphology during disease resolution. Conclusions: Acute anterior uveitis is associated with measurable macular functional impairment detectable by mfERG, even when structural OCT parameters appear relatively stable. These results suggest that inflammatory processes in AAU may extend beyond the anterior segment and transiently affect retinal function. mfERG may therefore serve as a sensitive adjunct tool for detecting and monitoring subclinical macular dysfunction in AANU. Clinical Relevance: Functional retinal impairment may persist despite apparent structural recovery in acute anterior uveitis. Incorporating mfERG into clinical evaluation may improve the detection of subtle macular involvement and enhance understanding of disease dynamics beyond conventional imaging findings. Full article

Objectives: The aim of this study was to analyze the association between cardiovascular risk factors such as glycated hemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-C), hypertension, overweight, and smoking and longitudinal anatomical and functional changes in diabetic macular edema (DME) during intravitreal therapy. Materials and Methods: This is a retrospective, observational, descriptive study conducted on a sample of 318 patients with DME associated with some degree of diabetic retinopathy (DR). They were treated with aflibercept, ranibizumab, and/or dexamethasone, assessing anatomical and functional outcomes through visual acuity, retinal thickness, and macular volume. Simultaneously, serum HbA1c and LDL-C levels, blood pressure, body mass index (BMI) and tobacco use were measured at baseline, 6, and 12 months to determine their association with treatment response using linear mixed models. Results: Of the variables analyzed in this study, HbA1c and degree of retinopathy were significantly associated with greater retinal thickness over time. Likewise, we found that, compared with aflibercept, dexamethasone intravitreal treatment was associated with greater retinal thickness over time. Concerning visual acuity, we found an inverse relationship with age, tobacco use and degree of retinopathy. Associations between outcomes and the initial intravitreal agent were observed; however, these findings should be interpreted cautiously. Conclusions: This study was consistent with previous research suggesting an association between glycemic control and DME response and progression. It also highlighted the importance of degree of retinopathy and intravitreal treatment in diabetic macular edema progression. Treatment-related findings represent exploratory associations and should not be interpreted as evidence of comparative effectiveness. Full article

Background: Pachychoroid pigment epitheliopathy (PPE) is a non-exudative entity within the pachychoroid disease spectrum characterized by increased choroidal thickness and isolated serous pigment epithelial detachment (PED) without subretinal fluid. Although photodynamic therapy (PDT) is established for chronic central serous chorioretinopathy (CSC), its efficacy in isolated pachychoroid-related PED remains insufficiently defined, with available evidence limited to small case series. Purpose: This study aims to characterize symptomatic pachychoroid-related PED and evaluate anatomical and functional outcomes following half-dose PDT (hd-PDT), with additional analysis according to lesion localization and CSC history. Methods: This retrospective study included 34 eyes of 27 patients treated with hd-PDT between June 2022 and December 2024. PEDs were categorized as central (fovea-involving) or paramacular. Best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography parameters—central subfield thickness (CST), mean subfield thickness (MST), macular volume (MV), subfoveal choroidal thickness (SFCT), and PED height—were assessed at baseline, 1 month, and 6 months. Treatment planning was based on indocyanine green angiography (ICGA) and spectral-domain optical coherence tomography (SD-OCT) findings. Statistical analyses employed non-parametric tests and generalized estimating equations. Results: Central lesions were associated with longer disease duration, worse baseline BCVA, and greater retinal thickness and PED height (p < 0.05). Complete PED resorption occurred in 79.4% of eyes at 1 month and 73.5% at 6 months (central: 86.3% and 81.8%; paramacular: 66.6% and 58.3%). Mean BCVA improved significantly from 0.22 ± 0.24 to 0.10 ± 0.16 logMAR at 6 months (p < 0.0001), with greater functional gain in central lesions. Significant reductions were observed in CST, MST, MV, and PED height, whereas SFCT remained stable. Better final BCVA correlated with younger age, shorter disease duration, smaller baseline retinal volume, smaller PDT spot size, and absence of CSC history. Non-responders had worse baseline BCVA, higher PED height, and larger treatment areas. No treatment-related complications were detected. Conclusions: Half-dose PDT was associated with favorable anatomical and functional outcomes in symptomatic pachychoroid-related PED, particularly in centrally located lesions. Baseline disease severity appeared to influence treatment response. Prospective studies with longer follow-up are warranted to confirm long-term efficacy and safety. Full article