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Ta-Ching Chen, Chung-May Yang, Muh-Shy Chen, Chang-Hao Yang, Jen-Pin Sun, Yi-Hsuan Wei; Imaging characteristics of peripapillary intrachoroidal cavitation and associated macular complications. Invest. Ophthalmol. Vis. Sci. 2014;55(13):282.
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To evaluate the imaging features of peripapillary intrachoroidal cavitation (ICC) and to report a case of associated macular complications
A retrospective, observational case series.All 18 eyes from 15 patients with the clinical diagnosis of ICC were enrolled. Image examinations included fundus photography, fundus autofluorescence (FAF), fluorescein angiography (FAG), and detailed Optical coherence tomography (OCT) scanning were performed. Statistical analysis was also performed to evaluate the relationship between imaging characteristics and clinical symptoms.
Our patients had a mean age of 51.0 ± 11.2 years. All eyes showed myopia degeneration with peripapillary atrophy. The mean spherical-equivalent refraction error was 10.5 ± 3.0 D. A typical, slightly elevated, patchy yellow-orange lesion with indistinct margins can be seen in every eye enrolled by fundus photography. The FAG showed early hypofluorescence without pooling or staining in late phase. Neither neovascular lesion nor obvious leaking point can be found by FAG. OCT of the lesion showed intrachoroidal hyporeflective space located below and separated from the normal plane of the RPE. Through detailed OCT scanning, more than half (53%) revealed direct communicating tract between the intrachoroidal cavity and the vitreous space. With long-term observation, we found a case of sensory retinal detachement in macular area. WIth the help of OCT, the subretinal fluid could be suspected communicating with ICC. The subretinal fluid seemed to be persistent for more than 6 months.
Peripapillary intrachoroidal cavitation is a relatively rare complication of high myopia. WIth the help of advanced imaging techniques, we can further explore the anatomical location and physiological properties of the lesion. FAF and FAG can help us differentiate this yellow-orange lesion from neovascular lesion. OCT scanning over the peripapillary area may help us to identify the pathophysiology. Most of these cases were stable in vision. However, it is also possible to have visual disturbance such as visual field defect with thinning of nerve fiber layer or vision loss associated with macular change.
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