The Clinical Characteristics Of Focal Choroidal Excavation

Purposes To evaluate the clinical characteristics of focal choroidal excavation(FCE).Methods Retrospective observational case series.The medical records of 36 patients(42 eyes) with focal choroidal excavation were reviewed.All patients had undergone slitlamp biomicroscopy,indirect ophthalmoscopy, measures of best-corrected visual acuity(BCVA) and optic coherence tomography(OCT).Parts of them had performed color photography,fundus fluorescein angiography(FFA) and indocyanine green angiography(ICGA).Results The 36 patients included 17 women(47.2%) and 19 men(52.8%).All subjects were Chinese. The mean age was 43.56±12.53 years( range, 22-75 years).Six patients had bilateral involvement(16.7%).12 patients(15eyes)were emmetropic(35.7%),and the others were myopic(64.3%) range form-0.15 to-6.5 diapers.Twenty-five eyes only had FCE.Eight eyes subsequently developed neovascularization;One eye subsequently developed absence of IS/OS. Eight FCE(32.0%) eyes had concurrent CNV.Seven FCE(16.7%) eyes had concurrent CSC。One FCE(2.4%) eyes had concurrent uveitis.In eyes with FCE but no complications,normal appearance or nonspecific pigment disturbance could be seen around the choroidal excavation on fundus examination images.Corresponding to the excavation,FFA revealed a window defect or invariable problems,whereas hypofluorescence could be found on ICGA images.The excavations involved the outer plexiform layer up to retinal pigmented epithelium(RPE).The retinal layers from inner nuclear layer to the retinal nerve fibre layer were almost undisturbed.The OCT scans revealed that 22 eyes had a single excavation and 3 eyes had two excavations.In 14 eyes, the OCT revealed the choroidal excavation was located subfoveally(56.0%),2 eyes had two excavations.In the other 11 eyes,it was eccentric(44.0%),1 eye had two excavations.The excavations involved the outer plexiform layer up to retinal pigmented epithelium(RPE).The retinal layers from inner nuclear layer to the retinal nerve fibre layer were almost undisturbed.The results for the FCE without significant complications: The mean BCVA was 0.69±0.22(range, 0.2-1.0). In 19 eyes(76.0%),spectral-domain optical coherence tomography revealed outer retinal layers conforming to retinal pigment epithelial alterations within the excavation(conforming FCE).In the other 4 eyes(24.0%),spectral-domain optical coherence tomography revealed a separation between the outer retina and the retinal pigment epithelium within the excavation(nonconforming FCE).8 FCE eyes(32.0%) were complicated with Choroidal neovascularization at follow- up visits.In 4 eyes, the OCT revealed the choroidal excavation was located subfoveally(50.0%).In the other 4 eyes, it was eccentric(50.0%).3 eyes were conforming FCE(37.5%);4 eyes were nonconforming FCE(62.5%).Seven FCE eyes with central serous chorioretinopathy were diagnosed on the basis of medical history, serous retinal detachment by fundus examination and OCT,and leakage at the RPE level by FA and ICGA.The OCT scans revealed that 6 eyes had a single excavation and 1 eyes had two excavations. In 4 eyes, the OCT revealed the choroidal excavation was located subfoveally(57.1%). In the other 3 eyes, it was eccentric(42.9%),1 eye had two excavations.Nine FCE eyes with Choroidal neovascularization were diagnosed on the basis of clinical, angiography and OCT findings.Hyperfluorescence representing classic CNV could be seen on FFA images.The OCT scans revealed that8 eyes had a single excavation and 1 eyes had two excavations.In 6 eyes, the OCT revealed the choroidal excavation was located subfoveally(77.8%). In the other 2 eyes, it was eccentric(22.2%),1 eye had two excavations.Seventeen FCE eyes were complicated with Choroidal neovascularization.The OCT scans revealed that 16 eyes had a single excavation and 1 eyes had two excavations.In 9 eyes,the OCT revealed the choroidal excavation was located subfoveally(52.9%).In the other 8 eyes,it was eccentric(47.1%).In eyes with CNV,hyperfluorescence representing classic CNV could be seen on FFA.All CNV lesions grew from the bottom or slope of the excavation. Choroidal neovascularization occurred in both conforming and nonconforming type FCEs,regardless of whether the excavation was shallow or deep,subfoveal or eccentric. All CNV lesions responded well to intravitreal injection of antievascular endothelial growth factor(VEGF) agents.Nonconforming FCE changed to the conforming type after successful treatment of CNV.However,one patient transformed from the conforming to the nonconforming type. Ultimately, all eyes exhibited the conforming FCE.One FCE eye was complicated with uveitis.The conforming FCE located subfoveally and had a single excavation.Hyperfluorescence of the optic disc could be seen on FFA and ICGA images.Conclusions Most of patients had unilateral involvement and secondly bilateral involvements.FCE might be not distinctly related to the refraction.The visual acuity was normal or impaired at different degrees. Although most lesions remain stable,secondary choroidal nevascularization and absence of IS/OS may occur.Clinical examination and color photography showed varying degrees of foveal pigmentary alterations,a yellowish spot or invariable at the edge of the fovea.The OCT images showed that all eyes had a single or twe choroidal excavation.FFA revealed a window defect or invariable problems, whereas hypofluorescence could be found on ICGA images.