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Ou Y, Qiu M, Li M, Mi Y, Wu D, Tang S, Dai W, Ma JH. Risk Factors for Focal Choroidal Excavation Concurrent with Chorioretinal Disease: Evaluated by Spectral-Domain OCT. OPHTHALMOLOGY SCIENCE 2024; 4:100554. [PMID: 39149710 PMCID: PMC11324813 DOI: 10.1016/j.xops.2024.100554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/29/2024] [Accepted: 05/17/2024] [Indexed: 08/17/2024]
Abstract
Purpose To investigate the risk factors for patients with focal choroidal excavation (FCE) and their correlation with chorioretinal diseases. Design Retrospective cross-sectional study. Subjects Patients with FCE were enrolled, while healthy subjects were recruited for the control group. Methods The study collected demographic information, clinical features, and multimodal images. Parameters of FCE identified using spectral-domain OCT (SD-OCT) were manually measured using built-in software and subsequently analyzed statistically. Main Outcome Measures Subfoveal choroidal thickness (SFCT), subexcavation choroidal thickness (SECT), and the greatest depth and width of each excavation were manually measured using built-in calipers in OCT software. Results Twenty-one patients (13/8, male/female) with FCE were included in this study. The average age was 45.2 years, and their best-corrected visual acuity (BCVA) was 0.4 logarithm of the minimum angle of resolution (Snellen equivalent, 20/50). Focal choroidal excavation was present in 28 eyes of 21 patients, including isolated FCE (12 eyes) and complicated FCE (16 eyes) with choroidal neovascularization (sCNV), central serous chorioretinopathy, and other conditions. Patients with complicated FCE were significantly older than those isolated FCE (P = 0.015). The SFCT of the healthy subjects was significantly less than that of the fellow eyes of the patients with FCE (P < 0.01), as was that of the eyes with isolated FCE (P < 0.001) and complicated FCE (P < 0.001). The width of excavation was wider in eyes with complicated FCE than in those with isolated FCE (P = 0.001). Hypertransmission defect (HD) was found beneath 15 excavations and was more prevalent in the complicated FCE group than the isolated FCE group (P = 0.023). Conclusions Focal choroidal excavation appears to be closely related to chorioretinal disorders, and the width of the excavation is a significant indicator for evaluating the risk of chorioretinal diseases. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Yiwen Ou
- Aier Academy of Ophthalmology, Central South University, Changsha, Hunan, China
| | - Minghui Qiu
- Department of Retinal and Vitreous Diseases, Foshan Aier Eye Hospital, Foshan, Guangdong, China
| | - Mengyuan Li
- Department of Retinal and Vitreous Diseases, Guangzhou Aier Eye Hospital, Guangzhou, Guangdong, China
| | - Yajun Mi
- Department of Retinal and Vitreous Diseases, Guangzhou Aier Eye Hospital, Guangzhou, Guangdong, China
| | - Dezheng Wu
- Department of Retinal and Vitreous Diseases, Guangzhou Aier Eye Hospital, Guangzhou, Guangdong, China
| | - Shibo Tang
- Aier Academy of Ophthalmology, Central South University, Changsha, Hunan, China
- Department of Retinal and Vitreous Diseases, Guangzhou Aier Eye Hospital, Guangzhou, Guangdong, China
| | - Weiwei Dai
- Department of Retinal and Vitreous Diseases, Changsha Aier Eye Hospital, Changsha, Hunan, China
| | - Jacey Hongjie Ma
- Aier Academy of Ophthalmology, Central South University, Changsha, Hunan, China
- Department of Retinal and Vitreous Diseases, Guangzhou Aier Eye Hospital, Guangzhou, Guangdong, China
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Bai J, Wang Y, Cao N, Liu Y, Chen X, He T, Wang S. Bilateral Focal Choroidal Excavation and Central Serous Chorioretinopathy Coexisting in a Male Patient. Case Rep Ophthalmol Med 2024; 2024:5519361. [PMID: 38566845 PMCID: PMC10987251 DOI: 10.1155/2024/5519361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/18/2024] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Background Here, we report a case of a male patient with bilateral focal choroidal excavation (FCE) and central serous chorioretinopathy (CSC). A 33-year-old man complained of mild blurring of vision in the right eye. Optical coherence tomography (OCT) revealed FCE in both eyes, with subretinal fluid in both eyes and serous pigment epithelial detachment in the right eye. Standard laser fluence (50 J/cm2) was used in the right eye, and a subthreshold micropulse laser (SML) was simultaneously used in the left eye. Follow-up visits were recommended. At his last visit (5 months after treatment), the visual acuity was 16/20 in the right eye and 20/20 in the left eye and OCT showed a completed resolution of SRF. Conclusion FCE is defined as a localized depression of the choroid detected by OCT. It may be congenital or acquired secondarily. We present a case of uncommon focal choroidal excavation and central serous chorioretinopathy (CSC) coexisting in both eyes at a relatively young age in which visual acuity was improved and subretinal fluid (SRF) completely resolved with laser treatment. Timely treatment can promote SRF absorption and improve vision.
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Affiliation(s)
- Jie Bai
- Department of Ophthalmology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang, China
| | - Yanqing Wang
- Department of Ophthalmology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang, China
| | - Nanjue Cao
- Department of Ophthalmology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang, China
| | - Yan Liu
- Department of Ophthalmology and Otorhinolaryngology, Yiwu Second People's Hospital, Yiwu 322000, Zhejiang, China
| | - Xufei Chen
- Department of Ophthalmology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang, China
| | - Ting He
- Department of Ophthalmology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang, China
| | - Shan Wang
- Department of Oral Pathology, School of Stomatology, Hainan Medical University, Haikou 571199, China
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El Matri K, Saidane R, Bouazzaoui O, Hachicha I, Falfoul Y, Matri LE. Multimodal imaging of focal choroidal excavation and macular choroidal cavitation associated to choroidal neovascularization. Eur J Ophthalmol 2024; 34:NP56-NP62. [PMID: 37670500 DOI: 10.1177/11206721231198884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Purpose: To report multimodal imaging features of an unusual case of multiple focal choroidal excavations (FCE) associated to macular intrachoroidal cavitations (ICC) and choroidal neovascularization (CNV) in a non-myopic patient with normal choroidal thickness. Methods: Observational case report. Results: A 69-year-old non-myopic male patient with history of macular CNV of unknown etiology in the right eye (RE), initially treated with Bevacizumab intravitreal injections with significant improvement of visual acuity. He presented with acute vision loss in the same eye related to recurrent CNV exudation. Multimodal imaging of the RE confirmed the diagnosis of active type 2 CNV, associated to multiple FCE. Besides, it highlighted incidental unusual macular ICC in the same eye. Choroidal thickness was within normal limits (217 μm). Conclusion: Focal choroidal excavations and intrachoroidal cavitations can be observed in emmetropic patients in the absence of pachychoroid disease. In presence of CNV of unknown etiology, complete multimodal imaging can be of a great help to better define choroidal anomalies, allowing structural and vascular correlations between different lesions. Key words: Focal choroidal excavation; Choroidal cavitation; Multimodal imaging.
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Affiliation(s)
- Khaled El Matri
- Institut Hédi Rais d'ophtalmologie de Tunis, Department B, Tunis, Tunisia
- Oculogenetic laboratory LR14SP01, Tunis, Tunisia
- Université de Tunis - El Manar / Faculté de médecine de Tunis, Tunis, Tunisia
| | - Rahma Saidane
- Institut Hédi Rais d'ophtalmologie de Tunis, Department B, Tunis, Tunisia
- Université de Tunis - El Manar / Faculté de médecine de Tunis, Tunis, Tunisia
| | - Ouafi Bouazzaoui
- Institut Hédi Rais d'ophtalmologie de Tunis, Department B, Tunis, Tunisia
- Université de Tunis - El Manar / Faculté de médecine de Tunis, Tunis, Tunisia
| | - Iness Hachicha
- Institut Hédi Rais d'ophtalmologie de Tunis, Department B, Tunis, Tunisia
- Université de Tunis - El Manar / Faculté de médecine de Tunis, Tunis, Tunisia
| | - Yousra Falfoul
- Institut Hédi Rais d'ophtalmologie de Tunis, Department B, Tunis, Tunisia
- Oculogenetic laboratory LR14SP01, Tunis, Tunisia
- Université de Tunis - El Manar / Faculté de médecine de Tunis, Tunis, Tunisia
| | - Leila El Matri
- Institut Hédi Rais d'ophtalmologie de Tunis, Department B, Tunis, Tunisia
- Oculogenetic laboratory LR14SP01, Tunis, Tunisia
- Université de Tunis - El Manar / Faculté de médecine de Tunis, Tunis, Tunisia
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Capellan P, Gonzalez LA, Abdallah Mahrous M, Weiss SJ, Botsford B, Lenis TL, Ryan M, Orlin A, Papakostas T, Kiss S, D'Amico D, Kovacs K. Primary and secondary focal choroidal excavation morphologic phenotypes, associated ocular disorders and prognostic implications. Br J Ophthalmol 2023; 107:373-379. [PMID: 34656984 DOI: 10.1136/bjophthalmol-2021-319569] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/29/2021] [Indexed: 11/04/2022]
Abstract
AIMS To characterise and classify the morphological, clinical and tomographic characteristics of focal choroidal excavation (FCE) lesions to determine their prognostic implications. METHODS 36 eyes with FCE (32 patients) underwent multimodal imaging, including spectral domain optical coherence tomography and fundus autofluorescence. FCE lesions were classified into three subtypes: (1) type 1: myopic (central choroidal thickness: <100 µm), (2) type 2: suspected congenital (central choroidal thickness: 100-200 µm, without associated chorioretinal pathology) and (3) type 3: secondary or acquired (central choroidal thickness: >200 µm, with associated chorioretinal pathology). RESULTS 80.6% of eyes were followed longitudinally (26.8±18.8 months). There were 9 type 1 FCEs (myopic), 8 type 2 FCEs (U-shaped, congenital) and 19 type 3 FCEs (V-shaped, secondary). Type 2 FCEs trended towards larger maximum widths (p=0.0563). Type 3 FCEs were associated with central serous chorioretinopathy or pachyvessels (47.4%), but were also seen in pattern dystrophy, geographic atrophy, inactive choroiditis, torpedo maculopathy and adult-onset vitelliform dystrophy. Choroidal neovascular membranes (CNVMs) were more prevalent in type 3 FCE (41.2% compared with 11.1% for type 1 FCE, p=0.251, and 0% for type 2 FCE, p=0.043). CONCLUSIONS The FCE types, stratified by central choroidal thickness, demonstrated distinct morphological characteristics and associated findings. The classification scheme held prognostic implications as type 3 FCE with V shapes were associated with other chorioretinal conditions and were more likely to develop CNVM.
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Affiliation(s)
- Pamela Capellan
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Luis A Gonzalez
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - M Abdallah Mahrous
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Stephanie J Weiss
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Benjamin Botsford
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Tamara L Lenis
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Michael Ryan
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Anton Orlin
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Thanos Papakostas
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Szilard Kiss
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Donald D'Amico
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Kyle Kovacs
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
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Hua R, Zhang M. Imaging Characteristics of Neovascular and Atrophic Pachychoroidal Spectrum Diseases. Front Med (Lausanne) 2022; 9:891397. [PMID: 35860744 PMCID: PMC9289118 DOI: 10.3389/fmed.2022.891397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThis study qualitatively and quantitatively compared imaging characteristics between neovascular and atrophic pachychoroid spectrum disease (PSD) by optical coherence tomography (OCT), and OCT angiography (OCTA).MethodsThe subtypes of PSD were identified by multi-modality imaging approaches. Subfoveal choroidal thickness (SFCT), choroidal vascular index (CVI), and vascular density of choroidal neovascularization (CNV) were measured.ResultsThe CVI and SFCT of 174 PSD eyes were 67.6% ± 5.48% and 362.2 ± 131.88 μm, respectively. After adjustment for age, linear regression indicated that SFCT was positively associated with CVI (p < 0.001), and patched hyper-reflective lesions in choriocapillaris layers (p = 0.009). Compared with neovascular PSD eyes, atrophic PSD eyes had similar patient age (57.1 ± 16.72 years, p = 0.639), SFCT (332.0 ± 111.00 μm, p = 0.51), and CVI (67.6% ± 3.94%, p = 0.527). There were no differences between polypoidal choroidal vasculopathy (PCV) eyes with aneurysmal polypoidal lesions and PCV eyes with tangled polypoidal lesions in terms of age, CVI, SFCT, vascular density, or the occurrence of double layer signs (DLSs, all p > 0.05). Logistic regression indicated that age (p = 0.003), SFCT (p = 0.003), patched hyper-reflective lesions in choriocapillaris layers (p = 0.009), and DLSs (p < 0.001) were predictive factors for CNV progression in PSD eyes (all p < 0.05).ConclusionsOur study highlighted the similarities in SFCT and CVI between neovascular and atrophic PSD, both of which were late stage lesions. Besides, age, SFCT, patched hyper-reflective lesions in choriocapillaris layers, and DLSs were risk factors for CNV in PSD. Our results showed that atrophic PSD is an important change in the late stage of PSD disease, which is helpful for in-depth understanding of the pathological mechanism of PSD and corresponding intervention.
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Affiliation(s)
- Rui Hua
- Department of Ophthalmology, First Hospital of China Medical University, Shenyang, China
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Meixia Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Meixia Zhang
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Gan Y, Ji Y, Zuo C, Su Y, Liao N, Zhang X, Zeng Y, Wen F. CORRELATION BETWEEN FOCAL CHOROIDAL EXCAVATION AND UNDERLYING RETINOCHOROIDAL DISEASE: A Pathological Hypothesis From Clinical Observation. Retina 2022; 42:348-356. [PMID: 34608106 PMCID: PMC8765213 DOI: 10.1097/iae.0000000000003307] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate focal choroidal excavation (FCE) in eyes with various diseases using multimodal imaging modalities and to investigate the correlation of FCE and underlying chorioretinal diseases. METHODS This retrospective observational study included 62 eyes from 56 patients who were identified by optical coherence tomography as having FCE. All included patients underwent comprehensive clinical examinations and multimodal imaging to identify and detect the characteristics of FCE and its correlation with underlying chorioretinal diseases. RESULTS All included patients were of Chinese descent, and the median age at diagnosis was 43 years (range: 15-66). Seventy-three FCEs appeared in these included eyes. Most FCEs were formed at sites with anatomical changes caused by various chorioretinal diseases. Choroidal osteoma, punctate inner choroidopathy, and central serous chorioretinopathy were the most common etiologies of FCE. During follow-up, 14 eyes (22.58%) exhibited a pattern change and three eyes (4.84%) developed new-onset choroid neovascularization. CONCLUSION Focal choroidal excavation is a common sign found in a variety of chorioretinal diseases. Processes that involve impairment or tissue loss of the outer retina and inner choroid and disrupt the balance of intraocular pressure and choroidal pressure because of mechanical disturbance may play a role in FCE formation.
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Affiliation(s)
- Yuhong Gan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yuying Ji
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chengguo Zuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yongyue Su
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Nanying Liao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiongze Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yunkao Zeng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Feng Wen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Hua R, Duan J, Zhang M. Pachychoroid Spectrum Disease: Underlying Pathology, Classification, and Phenotypes. Curr Eye Res 2021; 46:1437-1448. [PMID: 34114902 DOI: 10.1080/02713683.2021.1942073] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Pachychoroid spectrum disease encompasses a set of macular disorders secondary to an abnormally thick choroid. However, the pathological process underlying pachychoroid spectrum disease and its overlap with age-related macular degeneration (AMD) remain unclear. This review aimed to understand the underlying pathology, classification, and phenotypes of pachychoroid spectrum disease. METHODS This comprehensive literature review was performed based on a search of peer-reviewed published papers relevant to the current knowledge of pachychoroid disease spectrum. RESULTS Pachychoroid is primarily a bilateral phenomenon; the main pathological lesions include choriocapillaris attenuation and abnormally dilated pachyvessels. Chronic central serous chorioretinopathy (CSC) and pachychoroid neovasculopathy (PNV) show similar morphological changes and angiogenic cytokine levels. The subretinal fluid in PNV may not accurately indicate PNV activity. Besides, types 1 and 2 of choroidal neovascularization (CNV) may be involved in primary pachychoroidal disease. Both choroidal arteriosclerosis and higher hydrostatic pressure contribute to hyalinized choroidal arteries and aneurysmal dilatations, resulting in PNV progression to polypoidal choroidal vasculopathy (PCV). Thus, pachychoroid-related type 2 CNV and chronic CSC could be considered as PNV (IIIc) and as a precursor of PNV (IIIa), respectively. Tangled PCV on optical coherence tomography angiography that fails to develop aneurysms should be classified as a subtype of PNV or a forme fruste of PCV. CONCLUSIONS Multiple disorders of the pachychoroid spectrum are considered as a continuous disease process, ultimately stimulated by choroidal malfunction. PCV overlaps both AMD and pachychoroid disease, especially for thin-choroid and bilateral types. The terminology and classification of pachychoroid spectrum disease should be used cautiously.
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Affiliation(s)
- Rui Hua
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Department of Ophthalmology, First Hospital of China Medical University, Shenyang, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Jianan Duan
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Meixia Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
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Sagar P, Sodhi PS, Roy S, Takkar B, Azad SV. Pachychoroid neovasculopathy: A comparative review on pathology, clinical features, and therapy. Eur J Ophthalmol 2021; 32:11206721211036290. [PMID: 34325545 DOI: 10.1177/11206721211036290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There have been major changes in our understanding of choroidal diseases in the last decade owing to multiple retinal and choroidal imaging related advances. A major conceptual pivot is establishment of pachychoroid and its spectrum of clinical disorders: pachychoroid pigment epitheliopathy, central serous chorioretinopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy/aneurysmal type 1 neovascularization, peripapillary pachychoroid syndrome, and focal choroidal excavation. However, considerable overlaps in manifestations and therapeutics of these disorders make differentiation amongst them difficult. This review is focused on pathogenesis and clinical aspects of pachychoroid neovasculopathy (PNV). Since PNV was defined as a separate entity around 5 years ago, there have been numerous contrasting observations surrounding it. We review and summarize these studies, and also compare PNV with other disorders of the pachychoroid spectrum in detail. There are important differences between etiologies of neovascular age related macular degeneration and PNV. Yet the current treatment strategies for PNV have been extrapolated from the trials for the former. Future research needs to validate this assumption with long-term results.
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Affiliation(s)
- Pradeep Sagar
- Department of Vitreo-Retina, Sankara Eye Hospital, Shivamogga, India
| | | | - Sangeeta Roy
- Department of Vitreo Retina, Susrut Eye Foundation and Research Centre, Kolkata, West Bengal, India
| | - Brijesh Takkar
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
- Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, Hyderabad, Telangana, India
| | - Shorya Vardhan Azad
- Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Arrigo A, Mansour A, Viganò C, Gorgoni F, Bandello F, Battaglia Parodi M. Progressive development of large choroidal excavation in neovascular age-related macular degeneration. Eur J Ophthalmol 2020; 32:1120672120981364. [PMID: 33325252 DOI: 10.1177/1120672120981364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE Focal choroidal excavation (CE) is an unusual concavity in the choroid without posterior staphyloma or scleral ectasia and with pathogenesis is still unknown. In this article we present a case of de novo progressive focal choroidal excavation associated with exudative age-related macular degeneration (AMD). METHODS This study was designed as a descriptive case report based on clinical and imaging data collected during patient's observation and follow-ups. RESULTS A 67-year-old man with systemic hypertension and hypercholesterolemia, with a previous diagnosis of bilateral AMD complicated by already treated macular neovascularization, underwent our attention to perform follow-up visits. Over the 5-year follow-up, the left eye remained stable, requiring no further treatments and disclosing a BCVA of 0.0 LogMAR. On the contrary, the right eye showed several exudation recurrences, requiring further anti-VEGF injections. Structural OCT detected the progressive development of a focal CE, which gradually enlarged converting into a large CE. Structural OCT examinations reported even growing defects of the Bruch's membrane. Despite the evident progression of the CE, BCVA disclosed stable values over the 5-years follow-up (1.0 LogMAR), with a worsening of metamorphopsia. CONCLUSION Large CE may be a complication of neovascular AMD. Bruch's membrane abnormalities, including thickness and reflectivity changes, detectable on structural OCT, can be considered early biomarkers of potentially developing CE.
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Affiliation(s)
- Alessandro Arrigo
- Scientific Institute San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Ahmad Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
- Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon
| | - Chiara Viganò
- Scientific Institute San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Francesca Gorgoni
- Scientific Institute San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Francesco Bandello
- Scientific Institute San Raffaele Hospital, Vita-Salute University, Milan, Italy
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