Peripheral Exudative Hemorrhagic Chorioretinopathy: Current Concepts, Multimodal Imaging, Differential Diagnosis and Emerging Therapeutic Perspectives

Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is an uncommon but likely underrecognized degenerative retinal disorder characterized by peripheral subretinal and sub-retinal pigment epithelium hemorrhagic and exudative lesions, predominantly affecting elderly individuals. The condition frequently mimics choroidal melanoma and other peripheral retinal diseases, often resulting in diagnostic uncertainty and occasionally unnecessary invasive procedures. Recent advances in multimodal imaging have substantially improved the recognition and characterization of PEHCR, suggesting possible associations with polypoidal choroidal vasculopathy and the pachychoroid disease spectrum. A narrative literature review was performed using PubMed/MEDLINE, Scopus, Embase, and Web of Science. Original studies, retrospective case series, multimodal imaging reports, and relevant review articles published in English were included according to their relevance to PEHCR epidemiology, imaging, pathogenesis, differential diagnosis, and treatment. Particular attention was devoted to recent developments in ultra-widefield imaging, optical coherence tomography, indocyanine green angiography, and optical coherence tomography angiography. PEHCR typically presents with peripheral subretinal hemorrhage, exudation, pigment epithelial detachments, and occasionally vitreous hemorrhage. Multimodal imaging, particularly ultra-widefield imaging and ICGA, has substantially improved the diagnosis of PEHCR and supports its relationship with the pachychoroid-PCV spectrum. Although many patients can be managed conservatively, individualized treatment based on lesion activity remains essential, while prospective studies are needed to establish evidence-based management strategies.