The Expanded Spectrum of Focal Choroidal Excavation

Abstract

Purpose: : To describe the clinical and multimodal imaging findings in patients with a focal choroidal excavation (FCE).

Methods: : This study was a retrospective observational case series. The medical records of 12 patients (13 eyes) with FCE were reviewed. Clinical histories and multimodal imaging findings including color photography, fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA), spectral domain optical coherence tomography (SD-OCT) and enhanced depth imaging SD-OCT (EDI-OCT) were analyzed.

Results: : The mean age of patients was 45 years (range 22 to 62 years). Five patients were Asian. Mean visual acuity was 20/31 (range: 20/20 to 20/100). Mean refractive error was -4.75 diopters (range +0.75 to -7.50 diopters). Unilateral lesions were seen in 11 of the 12 patients, and 1 patient had bilateral involvement. All lesions involved the fovea and manifested varying degrees of pigmentary changes that were usually hypoautofluorescent on FAF imaging. Most lesions appeared hypofluorescent with ICGA, but FA findings varied with the degree of retinal pigment epithelium (RPE) alterations. In 7 eyes, SD-OCT showed the outer retinal layers conforming to the RPE within the excavation. In the other 6 eyes, SD-OCT demonstrated a separation between the outer retina and RPE within the excavation. In 7 eyes studied with EDI-OCT, there was no evidence of scleral ectasia. Mean choroidal thickness of the uninvolved choroid was thicker than normal at 319 um (range 244 to 439 µm). All lesions remained stable except in 1 eye that had additional findings of central serous chorioretinopathy (CSC) and secondary type 2 (subretinal) neovascularization. One patient had a history of CSC in the fellow uninvolved eye.

Conclusions: : FCE is a newly described idiopathic entity in which there are one or more focal areas of choroidal excavation. In some patients, there may be an association with CSC. Although most lesions remain stable, secondary choroidal neovascularization may occur.

Keywords: macula/fovea • retina