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Ruiz-Chavolla D, Barragán-Arévalo T, Cortes-Muñoz D, Sánchez-Ruiz J, Zenteno JC, Ledesma-Gil G. Macular atrophy and focal choroidal excavation in a patient with JAG1- related alagille syndrome. Ophthalmic Genet 2024:1-4. [PMID: 38526149 DOI: 10.1080/13816810.2024.2303786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/05/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Alagille syndrome (AGS) is a genetic disease with multisystemic affection, including ocular manifestations. Recently, a high frequency of posterior segment findings, including macular changes, has been reported. This publication aims to report an unusual finding of macular atrophy and a focal choroidal excavation in a patient with JAG1 related AGS. METHODS Case report. RESULTS This publication describes an atypical presentation of focal choroidal excavation (FCE) and unilateral macular atrophy in a 7-year-old male with Alagille syndrome (AGS). Genetic analysis revealed a pathogenic variant in the JAG1 gene. Ophthalmological examination and imaging findings demonstrated characteristic ocular manifestations of AGS, including posterior embryotoxon, chorioretinal atrophy, and thinning of the choroid. CONCLUSION The presence of FCE in AGS is uncommon, and the underlying mechanisms remain unclear. Further exploration of similar cases is necessary to better understand the evolution and visual prognosis in patients with AGS and FCE.
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Affiliation(s)
- Diego Ruiz-Chavolla
- Retina Department, Institute of Ophthalmology, Fundación Conde de Valenciana, Mexico City, Mexico
| | | | - Daniel Cortes-Muñoz
- Retina Department, Institute of Ophthalmology, Fundación Conde de Valenciana, Mexico City, Mexico
| | - Jhoana Sánchez-Ruiz
- Retina Department, Institute of Ophthalmology, Fundación Conde de Valenciana, Mexico City, Mexico
| | - Juan Carlos Zenteno
- Genetics Department, Institute of Ophthalmology, Fundación Conde de Valenciana, Mexico City, Mexico
- Biochemistry Department, faculty of Medicine, UNAM, Mexico City, Mexico
| | - Gerardo Ledesma-Gil
- Retina Department, Institute of Ophthalmology, Fundación Conde de Valenciana, Mexico City, Mexico
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Zhioua Braham I, Haddar S, Boukari M, Mokrani M, Mili I, Zhioua R. Case Report: Complete tomographic resolution of focal choroidal excavation complicated with choroidal neovascularization after anti-VEGF treatment. F1000Res 2023; 12:1270. [PMID: 38515861 PMCID: PMC10955186 DOI: 10.12688/f1000research.141099.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 03/23/2024] Open
Abstract
Purpose We report a case of focal choroidal excavation (FCE) that resolved after intravitreal injection of anti-vascular endothelial growth factor (VEGF) for choroidal neovascularization (CNV) and we describe its tomographic features. Case report A 43-year-old female presented with blurred vision and metamorphopsia in her left eye (LE) evolving for 10 years. The best corrected visual acuity (BCVA) was 20/20 in the right eye and 20/32 in the LE. Fundus examination revealed the presence of a yellowish foveal lesion which corresponded to a conforming FCE associated to a pachychoroid on swept-source optical coherence tomography (OCT). The OCT-Angiography showed a foveal flow void in the choriocapillaris layer corresponding to the FCE area. Three years later, the patient complained of visual impairment, more metamorphopsia with a BCVA of 20/80 on her LE. The OCT showed intraretinal fluid with a foveal retinal pigment epithelium (RPE) detachment. The OCT-angiography confirmed the presence of CNV. Two months after one intravitreal bevacizumab injection, the OCT documented the complete resolution of macular edema, the regression of the CNV tissue and the restoration of a normal aspect of the fovea without any FCE. Her BCVA improved to 20/32 with resolution of the metamorphopsia. The OCT aspect remained stable during 3 years of follow-up. Conclusion CNV can develop in FCE and anti-VEGF therapy is a good option treatment. After treatment, FCE pattern can change et may completely resolve.
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Affiliation(s)
- Imène Zhioua Braham
- University of Tunis El Manar, faculty of medicine of Tunis, Tunis, Tunis, Tunisia
- Ophthalmology, Charles Nicolle University Hospital, Tunis, Tunis, Tunisia
| | - Selim Haddar
- University of Tunis El Manar, faculty of medicine of Tunis, Tunis, Tunis, Tunisia
- Ophthalmology, Charles Nicolle University Hospital, Tunis, Tunis, Tunisia
| | - Mejdi Boukari
- University of Tunis El Manar, faculty of medicine of Tunis, Tunis, Tunis, Tunisia
- Ophthalmology, Charles Nicolle University Hospital, Tunis, Tunis, Tunisia
| | - Manel Mokrani
- University of Tunis El Manar, faculty of medicine of Tunis, Tunis, Tunis, Tunisia
- Ophthalmology, Charles Nicolle University Hospital, Tunis, Tunis, Tunisia
| | - Ilhem Mili
- University of Tunis El Manar, faculty of medicine of Tunis, Tunis, Tunis, Tunisia
- Ophthalmology, Charles Nicolle University Hospital, Tunis, Tunis, Tunisia
| | - Raja Zhioua
- University of Tunis El Manar, faculty of medicine of Tunis, Tunis, Tunis, Tunisia
- Ophthalmology, Charles Nicolle University Hospital, Tunis, Tunis, Tunisia
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Garg A, Khaleel H, Wahab C, Yan P. Acquired Focal Choroidal Excavation Secondary to Pachychoroid Choroidal Neovascular Membrane After Central Serous Chorioretinopathy. J Vitreoretin Dis 2023; 7:340-343. [PMID: 37927310 PMCID: PMC10621713 DOI: 10.1177/24741264231163395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Purpose: To report a case of acquired conforming-type focal choroidal excavation (FCE) secondary to a pachychoroid choroidal neovascular membrane (CNVM) triggered by central serous chorioretinopathy (CSCR). Methods: A case and its findings were analyzed. Results: A 54-year-old Asian man who had spontaneous resolution of CSCR in the right eye presented with a pachychoroid CNVM and FCE 1 year after the initial CSCR diagnosis. Intravitreal antivascular endothelial growth factor injections were initiated, and the subretinal fluid and intraretinal hemorrhage resolved. The patient was followed for FCE progression for 3 years. Conclusions: Acquired FCE can occur secondary to CSCR and pachychoroid CNVM. The pathogenesis may be focal choroidal ischemia, choroidal vascular collapse, and fibrosis leading to choroidal excavation. This case highlights the progression of the spectrum of pachychoroid disorders from CSCR, pachychoroid CNVM, and subsequent acquired confirming-type FCE. Further research is needed to assess other diseases leading to acquired FCE and to determine the underlying mechanism.
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Affiliation(s)
- Anubhav Garg
- Department of Surgery, Division of Ophthalmology, McMaster University, Hamilton, ON, Canada
| | - Husam Khaleel
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Charbel Wahab
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Peng Yan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Kensington Vision and Research Centre, Toronto, ON, Canada
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Ratra D, Ratra V, Raviselvan M. Splitting of retinal pigment epithelium and Bruch's membrane due to a focal choroidal excavation. Oman J Ophthalmol 2023; 16:347-350. [PMID: 37602152 PMCID: PMC10433044 DOI: 10.4103/ojo.ojo_304_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/04/2023] [Indexed: 08/22/2023] Open
Abstract
We report an unusual finding of a split between the Bruch's membrane (BM) and retinal pigment epithelium (RPE) due to a focal choroidal excavation (FCE) in a healthy young girl with sudden onset visual disturbance. She was followed up regularly for over a year with serial optical coherence tomography (OCT) scans which revealed a parafoveal conforming type of FCE. Initial retinal edema subsided in a month. No associated pathology, such as a choroidal neovascular membrane, was seen. A split was seen between the RPE and the BM on one side of the FCE, which remained unchanged. We postulate this novel finding of the split between the RPE and BM to be due to the inelasticity of the BM, causing it to separate from the RPE due to the sudden outward force exerted during the formation of an FCE.
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Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Vineet Ratra
- Department of Comprehensive Ophthalmology, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Munispriyan Raviselvan
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Stepanov A. CURRENT VIEW OF THE SPECTRUM OF PACHYCHOROID DISEASES. A REVIEW. Cesk Slov Oftalmol 2023; 3:1001-1005. [PMID: 36858943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
INTRODUCTION The term "pachychoroid" (greek pachy- [παχύ] - thick) was first used by Warrow et al. in 2013. It is defined as an abnormal and permanent increase in choroidal thickness ≥ 300 μm, which is caused by dilatation of the choroidal vessels of the Haller's layer, thinning of the Sattler's layer and the choriocapillaris layer. METHODOLOGY Literary research focused on the current view of pachychoroid spectrum diseases, including clarification of the pathophysiological theories of the formation of "pachychoroid". RESULTS It is assumed that "pachychoroid" disease has an autosomal dominant type of heredity. Depending on the further activity of various exogenous and/or endogenous factors, pachychoroid diseases may appear. According to the current knowledge, the spectrum of pachychoroid disease covers six clinical entities: pachychoroid pigment epitheliopathy, central serous chorioretinopathy, pachychoroid neovasculopathy, polypoid choroidal vasculopathy, focal choroidal excavation and peripapillary pachychoroid syndrome. In this study, we describe the clinical symptoms and objective findings of focal choroidal excavation and peripapillary pachychoroid syndrome. The current pathophysiological theory of pachychoroid diseases is based on impaired venous outflow from the choroid ("venous overload choroidopathy") and thickening of the sclera in the eyes of affected patients. CONCLUSION Pachychoroid diseases should be included in the differential diagnosis of characteristic features observed during multimodal imaging analysis of choroidal changes.
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Stepanov A. CURRENT VIEW OF THE SPECTRUM OF PACHYCHOROID DISEASES. A REVIEW. Cesk Slov Oftalmol 2023; 79:163-166. [PMID: 37567771 DOI: 10.31348/2023/9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
INTRODUCTION The term "pachychoroid" (greek pachy- [παχύ] - thick) was first used by Warrow et al. in 2013. It is defined as an abnormal and permanent increase in choroidal thickness ≥ 300 μm, which is caused by dilatation of the choroidal vessels of the Haller's layer, thinning of the Sattler's layer and the choriocapillaris layer. METHODOLOGY Literary research focused on the current view of pachychoroid spectrum diseases, including clarification of the pathophysiological theories of the formation of "pachychoroid". RESULTS It is assumed that "pachychoroid" disease has an autosomal dominant type of heredity. Depending on the further activity of various exogenous and/or endogenous factors, pachychoroid diseases may appear. According to the current knowledge, the spectrum of pachychoroid disease covers six clinical entities: pachychoroid pigment epitheliopathy, central serous chorioretinopathy, pachychoroid neovasculopathy, polypoid choroidal vasculopathy, focal choroidal excavation and peripapillary pachychoroid syndrome. In this study, we describe the clinical symptoms and objective findings of focal choroidal excavation and peripapillary pachychoroid syndrome. The current pathophysiological theory of pachychoroid diseases is based on impaired venous outflow from the choroid ("venous overload choroidopathy") and thickening of the sclera in the eyes of affected patients. CONCLUSION Pachychoroid diseases should be included in the differential diagnosis of characteristic features observed during multimodal imaging analysis of choroidal changes.
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Stepanov A. CURRENT VIEW OF THE SPECTRUM OF PACHYCHOROID DISEASES. A REVIEW. Cesk Slov Oftalmol 2023; 3:1001-1005. [PMID: 38016808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
INTRODUCTION The term "pachychoroid" (greek pachy- [παχύ] - thick) was first used by Warrow et al. in 2013. It is defined as an abnormal and permanent increase in choroidal thickness ≥ 300 μm, which is caused by dilatation of the choroidal vessels of the Haller's layer, thinning of the Sattler's layer and the choriocapillaris layer. METHODOLOGY Literary research focused on the current view of pachychoroid spectrum diseases, including clarification of the pathophysiological theories of the formation of "pachychoroid". RESULTS It is assumed that "pachychoroid" disease has an autosomal dominant type of heredity. Depending on the further activity of various exogenous and/or endogenous factors, pachychoroid diseases may appear. According to the current knowledge, the spectrum of pachychoroid disease covers six clinical entities: pachychoroid pigment epitheliopathy, central serous chorioretinopathy, pachychoroid neovasculopathy, polypoid choroidal vasculopathy, focal choroidal excavation and peripapillary pachychoroid syndrome. In this study, we describe the clinical symptoms and objective findings of focal choroidal excavation and peripapillary pachychoroid syndrome. The current pathophysiological theory of pachychoroid diseases is based on impaired venous outflow from the choroid ("venous overload choroidopathy") and thickening of the sclera in the eyes of affected patients. CONCLUSION Pachychoroid diseases should be included in the differential diagnosis of characteristic features observed during multimodal imaging analysis of choroidal changes.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Montesel A, Eandi CM, Zografos L. Focal choroidal excavation associated with nonmelanocytic iris tumor. Eur J Ophthalmol 2022; 33:NP84-NP87. [PMID: 35001692 DOI: 10.1177/11206721211073210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe a unique unilateral association between an iris stromal tumor and a macular focal choroidal excavation. CASE DESCRIPTION A 40-year old patient presented with a small iris tumor associated with a unilateral macular lesion disclosed during a routine ophthalmologic examination. The patient was asymptomatic and visual function was not affected. After clinical and instrumental evaluation, a diagnosis of nonmelanocytic undefined stromal tumor of the iris associated with macular focal choroidal excavation was made. The size and shape of the two lesions remained stable during a 7-year follow-up and the patient did not develop other signs. CONCLUSION The concurrent presence of a stromal iris tumor associated with focal choroidal excavation has never been reported. Further reports of this association are required in order to understand its exact pathogenesis.
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Affiliation(s)
- Andrea Montesel
- Department of Ophthalmology, University of Lausanne, 60542Fondation Asile des Aveugles, 60541Jules Gonin Eye Hospital, Lausanne, Switzerland
| | - Chiara M Eandi
- Department of Ophthalmology, University of Lausanne, 60542Fondation Asile des Aveugles, 60541Jules Gonin Eye Hospital, Lausanne, Switzerland.,Department of Surgical Science, University of Torino, Torino, Italy
| | - Leonidas Zografos
- Department of Ophthalmology, University of Lausanne, 60542Fondation Asile des Aveugles, 60541Jules Gonin Eye Hospital, Lausanne, Switzerland
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Priya BV, Gupta I, Poornachandra B, Jayadev C, Pereira A, Mohapatra A, Krishna SG, Yadav NK. Morphological features of focal choroidal excavation and its association with macular pathology in Asian Indian eyes. Indian J Ophthalmol 2021; 69:886-889. [PMID: 33727453 PMCID: PMC8012939 DOI: 10.4103/ijo.ijo_569_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To study the characteristics of focal choroidal excavation (FCE) in Indian eyes based on spectral-domain optical coherence tomography (SD-OCT) findings and their association with macular pathologies. Methods Retrospective study of 26 patients diagnosed with FCE. All patients' clinical and imaging data were reviewed. Results There were eight females and 18 males aged between 24 and 85 years. FCE was noted in 31 eyes of 26 patients - unilateral in 21 and bilateral in 5. The conforming type was noted in 13 and nonconforming in 19 eyes. The location was extrafoveal in 16 and subfoveal in 15 eyes. The morphology was bowl-shaped in 24, cone-shaped in six eyes, and mixed type in one eye. Associated pathologies were central serous chorioretinopathy in nine eyes, choroidal neovascular membrane in seven eyes, Stargardt's disease in three eyes, Best disease in four eyes, other retinal dystrophies in two eyes, polypoidal choroidal vasculopathy and moderate non-proliferative diabetic retinopathy, each in one eye. The mean FCE width was 1667.2 ± 817.7 μ, mean depth was 95.7 ± 46.4 μ, and the mean choroidal thickness under the FCE was 234.8 ± 85.9 μ. No abnormal choroidal tissue was found under any FCE. Conclusion FCE is a relatively common entity and frequently associated with macular pathologies. The presence of an FCE did not alter the course or management of these conditions.
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Affiliation(s)
- B V Priya
- Department of Vitreo-Retina, Narayana Nethralaya Eye Institute, Bangalore, Karnataka, India
| | - Ishank Gupta
- Department of Vitreo-Retina, Narayana Nethralaya Eye Institute, Bangalore, Karnataka, India
| | - B Poornachandra
- Department of Vitreo-Retina, Narayana Nethralaya Eye Institute, Bangalore, Karnataka, India
| | - Chaitra Jayadev
- Department of Vitreo-Retina, Narayana Nethralaya Eye Institute, Bangalore, Karnataka, India
| | - Arpitha Pereira
- Department of Vitreo-Retina, Narayana Nethralaya Eye Institute, Bangalore, Karnataka, India
| | - Ayushi Mohapatra
- Department of Vitreo-Retina, Narayana Nethralaya Eye Institute, Bangalore, Karnataka, India
| | - Santosh G Krishna
- Department of Vitreo-Retina, Narayana Nethralaya Eye Institute, Bangalore, Karnataka, India
| | - Naresh K Yadav
- Department of Vitreo-Retina, Narayana Nethralaya Eye Institute, Bangalore, Karnataka, India
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Abstract
The structure and functions of the choroid have been long acknowledged but the pathophysiology behind various anomalies has been difficult to understand until the advent of optical coherence tomography (OCT). With OCT imaging, choroidal cavitations appear as optically empty spaces between the outer retinal and choroidal layers with attenuation or loss of outer retinal layers. Choroidal cavitations are found in the posterior pole and seen in conditions such as pathologic myopia, north carolina macular dystrophy (NCMD), focal choroidal excavation (FCE), and torpedo maculopathy (TM). To date, these disorders have not been linked. A commonality they all share is malformation of the RPE-photoreceptor-choroid complex. The following report describes the differences and similarities of choroidal cavitation amongst the different retinal disorders and emphasizes the importance of multimodal imaging in the detection and management of potential complications.
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Affiliation(s)
- Sandra Nassar
- Eye Department, Charlotte Eye, Ear, Nose, and Throat Associates, Charlotte, NC 28210, USA
| | - Aaron K Tarbett
- Eye Department, WG Hefner VA Medical System, Salisbury, NC 28144, USA
| | - David J Browning
- Eye Department, Charlotte Eye, Ear, Nose, and Throat Associates, Charlotte, NC 28210, USA
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Mishra S, Garg B, Senger D, Kumar A, Somarajan AC, Goel S, Saurabh K, Roy R. Focal choroidal excavation and giant choroidal cavern in an eye with pachychoroid. Oman J Ophthalmol 2020; 13:155-157. [PMID: 33542606 PMCID: PMC7852426 DOI: 10.4103/ojo.ojo_189_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/12/2020] [Accepted: 09/06/2020] [Indexed: 11/04/2022] Open
Abstract
Focal choroidal excavation (FCE) is a localized excavation of the choroid, which can be diagnosed by enhanced depth optical coherence tomography (OCT). Choroidal caverns are focal cavitation areas in the choroid which appear hyporeflective on OCT. These are angular or round, empty spaces with posterior tail of hypertransmission. A 47-year-old female presented to us for a routine eye check-up. The best-corrected visual acuity was 20/20 in both the eyes. On fundus examination, a localized pigmented lesion was seen in the right eye inferior to the optic disc, while the fundus of the left eye was normal. Spectral-domain OCT scan through the lesion showed an FCE and a giant cavern with a posterior tail of hypertransmission. The diameter of the cavern was 977 μ ×264 μ, with a subfoveal choroidal thickness (SFCT) of 360 μ. The SFCT of the other eye was 300 μ. Coexistence of FCE and cavern in an eye with thickened choroid is not yet reported in the literature, and their coexistence provides possible insight into the formation of FCE and caverns in the setting of thickened choroid.
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Affiliation(s)
- Samarth Mishra
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | - Barun Garg
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | - Deepak Senger
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | - Anushree Kumar
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | - Ashwin C Somarajan
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | - Sugandha Goel
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | - Kumar Saurabh
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | - Rupak Roy
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
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14
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Abstract
PURPOSE To report the morphological and clinical features of a case of myopic macular degeneration with large choroidal excavation. METHODS A myopic patient underwent multimodal imaging, including optical coherence tomography and fluorescein angiography, over a 8-year follow-up. RESULTS A choroidal excavation was found in left eye, superior to the fovea. The excavation started as a focal choroidal excavation (FCE) and got deeper and larger during the 8-years-long follow-up, thus resulting in a large choroidal excavation (LCE). CONCLUSIONS LCE may be the evolution of FCE in highly myopic eyes, further studies are needed to describe the natural history of choroidal excavations in degenerative myopia.
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Affiliation(s)
- Federico Borghesan
- Department of Ophthalmology, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Alessandro Arrigo
- Department of Ophthalmology, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
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15
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Inanc M, Tekin K, Teke MY, Kiziltoprak H. Tomographic characteristics of focal choroidal excavation and its association with retinal disorders. Eur J Ophthalmol 2020; 31:1154-1160. [PMID: 32452223 DOI: 10.1177/1120672120927862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the morphological, clinical, and tomographic characteristics of focal choroidal excavation in the context of concomitant retinal pathologies. METHODS This case series included 13 eyes of 13 patients with focal choroidal excavation diagnosed by spectral-domain optical coherence tomography. Morphologic characteristics of excavation and quantitative thicknesses of retinal layers and choroid were analyzed in excavation area, area adjacent to excavation, and fellow eye without focal choroidal excavation by spectral-domain optical coherence tomography. RESULTS At the initial examinations, one eye had a history of blunt trauma, three eyes were diagnosed with choroidal neovascularization, one with choroidal osteoma, one with angioid streaks, one with retinal detachment, one with diabetic macular edema, one with optic pit, one with torpedo maculopathy, and the rest three with idiopathic focal choroidal excavation. The mean choroidal thickness in the area of focal choroidal excavation was statistically significantly thinner compared to in the area adjacent to focal choroidal excavation and fellow eye (p < 0.001) and total average outer nuclear layer thickness was statistically significantly thicker in the area of excavation compared with fellow eye (p = 0.007). CONCLUSION This study confirmed the presence of focal choroidal excavation in various ocular diseases and the evaluation of focal choroidal excavation using the spectral-domain optical coherence tomography demonstrated choroidal thinning and outer nuclear layer thickening in the area of the excavation.
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Affiliation(s)
- Merve Inanc
- Ophthalmology Department, Ercis State Hospital, Van, Turkey
| | - Kemal Tekin
- Ophthalmology Department, Ercis State Hospital, Van, Turkey
| | - Mehmet Yasin Teke
- Ulucanlar Eye Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Hasan Kiziltoprak
- Ulucanlar Eye Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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16
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Rajabian F, Arrigo A, Grazioli A, Sperti A, Bandello F, Battaglia Parodi M. Focal choroidal excavation and pitchfork sign in choroidal neovascularisation associated with choroidal osteoma. Eur J Ophthalmol 2019; 31:NP67-NP70. [PMID: 31813301 DOI: 10.1177/1120672119892802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe a complex case of choroidal osteoma complicated by choroidal neovascularisation and focal choroidal excavation and presence of pitchfork sign. METHODS A young female patient with confirmed diagnosis of choroidal osteoma was followed up for 5 years. Multimodal imaging including optical coherence tomography and fluorescein angiography (Spectralis HRA + OCT; Heidelberg Engineering, Heidelberg, Germany) was performed. RESULTS Optical coherence tomography showed the presence of a unilateral choroidal osteoma in the first visit which was later followed by the appearance of focal choroidal excavation. After 3 years, choroidal neovascularisation developed in choroidal osteoma area, with subretinal fluid, subretinal hyper-reflective material, hyper-reflective foci and pitchfork sign. Decalcification of the tumour was not noted in this patient. Treatment with one intravitreal injection of Aflibercept resulted in complete disappearance of subretinal fluid, subretinal hyper-reflective material, pitchfork sign and decreased hyper-reflective foci. CONCLUSION Inflammatory response can be a propulsive element in the development of focal choroidal excavation and choroidal neovascularisation in choroidal osteoma patients.
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Affiliation(s)
- Firuzeh Rajabian
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Arrigo
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessio Grazioli
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Sperti
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
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17
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Basavaraj TM, Galiyugavaradhan S. Sequential imaging of a case of choroidal osteoma using swept-source OCT and optical coherence tomography angiography: A 4-year follow-up study. Indian J Ophthalmol 2019; 67:2097-2100. [PMID: 31755474 PMCID: PMC6896548 DOI: 10.4103/ijo.ijo_919_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 33-year-old gentleman was presented with metamorphopsia in the left eye due to choroidal osteoma (CO) complicated by choroidal neovascular membrane (CNVM). Optical coherence tomography angiography (OCTA) proved to be a valuable, noninvasive tool in monitoring treatment response of CNVM. The tumor subsequently underwent decalcification over a period of 4 years. In addition, SS-OCT scans were instrumental in documenting the natural course of the tumor and focal choroidal excavations (FCE), which were found in correspondence with tumor decalcification. Close follow-up is warranted in FCE, secondary to decalcification of CO, as CNVM has been documented to occur on the slope or bottom of eyes with FCE.
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Affiliation(s)
- Thirumalesh M Basavaraj
- Department of Retina, Narayana Nethralaya, Narayana Health City, Bommasandra, Bengaluru, Karnataka, India
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18
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Jain NF, Manayath GJ, Narendran V, Saravanan VR, Kumarasamy K, Appanraj R. A rare case of focal choroidal excavation associated choroidal neovascularization in angioid streaks. Oman J Ophthalmol 2019; 12:200-202. [PMID: 31902999 PMCID: PMC6826599 DOI: 10.4103/ojo.ojo_61_2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The purpose is to report a case of focal choroidal excavation (FCE) in a patient with angioid streaks (ASs) associated with secondary choroidal neovascularization (CNV). A 26-year-old man was referred for the treatment of CNV. On further evaluation, he was found to have ASs and optical coherence tomography revealed the presence of the choroidal neovascular complex associated with FCE. The patient was treated with a single dose of intravitreal bevacizumab (1.25 μg/0.05 ml). There was resolution of the lesion, and on further follow-up over 6 months, there were no recurrences. CNV in patients with ASs may also be associated with FCE. These patients have a good response to intravitreal antivascular endothelial growth factor injection.
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Affiliation(s)
- Nidhee F Jain
- Department of Vitreoretinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - George J Manayath
- Department of Vitreoretinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - V Narendran
- Department of Vitreoretinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - V R Saravanan
- Department of Vitreoretinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Karan Kumarasamy
- Department of Vitreoretinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Ramya Appanraj
- Department of Vitreoretinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
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19
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Abstract
We report the imaging characteristics of focal choroidal excavation (FCE) and associated choroidal neovascular membrane (CNVM) and interpret the probable etiopathogenesis of FCE through findings in four patients detected by spectral-domain optical coherence tomography (SD-OCT). FCE was found as an acquired entity in two of our cases subsequent to treatment of CNVM, whereas in the two other cases FCE was pre-existing. Furthermore, association of FCE with pachychoroid spectrum is reaffirmed through this case series.
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Affiliation(s)
- Raj C Shah
- Department of Vitreo-Retina, Giridhar Eye Institute, Ponneth Temple Road, Kadavanthra, Cochin, Kerala, India
| | - Mahesh Gopalakrishnan
- Department of Vitreo-Retina, Giridhar Eye Institute, Ponneth Temple Road, Kadavanthra, Cochin, Kerala, India
| | - Anubhav Goyal
- Department of Vitreo-Retina, Giridhar Eye Institute, Ponneth Temple Road, Kadavanthra, Cochin, Kerala, India
| | - Giridhar Anantharaman
- Department of Vitreo-Retina, Giridhar Eye Institute, Ponneth Temple Road, Kadavanthra, Cochin, Kerala, India
| | - Abhishek Sethia
- Department of Vitreo-Retina, Giridhar Eye Institute, Ponneth Temple Road, Kadavanthra, Cochin, Kerala, India
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20
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Tang WY, Zhang T, Shu QM, Jiang CH, Chang Q, Zhuang H, Xu GZ. Focal choroidal excavation complicated with choroidal neovascularization in young and middle aged patients. Int J Ophthalmol 2019; 12:980-984. [PMID: 31236356 DOI: 10.18240/ijo.2019.06.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/23/2019] [Indexed: 12/20/2022] Open
Abstract
AIM To investigate the clinical and optical coherence tomography (OCT) features of focal choroidal excavation (FCE) complicated with choroidal neovascularization (CNV) in young and middle aged patients. METHODS We performed a retrospective review of 26 patients with FCE accompanied by CNV. All patients underwent a complete ophthalmic examination. We analyzed the clinical characteristics of patients, focusing on the spectral-domain OCT features. All patients received intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents. And we assessed the changes of central retinal thickness and best-corrected visual acuity (BCVA) after anti-VEGF therapy. RESULTS The mean age of 26 patients was 35.5±7.3y (range, 21-48y). Of the 26 FCE lesions, 11 were located subfoveal, 6 were parafoveal, and 9 were extrafoveal. The mean FCE depth was 129.8±50.3 µm, and the mean width was 901.3±306.0 µm. The FCE depth was correlated positively with the width, but not correlated with age or refractive error. CNV was located within the excavation (19 eyes) or adjacent to the excavation (7 eyes). After anti-VEGF therapy, the central retinal thickness was significantly reduced and the BCVA was significantly improved. In the absorption process of subretinal fluid, we found that the fluid in the excavations needed to be absorbed at the last. A small amount of residual fluid could still be seen in a few deep excavations even after a long-term follow-up. CONCLUSION FCE may be an important reason to cause CNV. Especially in young patients with idiopathic CNV, we should pay attention to the use of OCT to check the presence of FCE. Anti-VEGF therapy is generally effective for CNV associated with FCE.
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Affiliation(s)
- Wen-Yi Tang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai 200031, China.,Key Laboratory of Visual Impairment, Restoration of Shanghai and Key Laboratory of Myopia of State Health Ministry, Fudan University, Shanghai 200031, China
| | - Ting Zhang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai 200031, China.,Key Laboratory of Visual Impairment, Restoration of Shanghai and Key Laboratory of Myopia of State Health Ministry, Fudan University, Shanghai 200031, China
| | - Qin-Meng Shu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai 200031, China.,Key Laboratory of Visual Impairment, Restoration of Shanghai and Key Laboratory of Myopia of State Health Ministry, Fudan University, Shanghai 200031, China
| | - Chun-Hui Jiang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai 200031, China
| | - Qing Chang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai 200031, China
| | - Hong Zhuang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai 200031, China.,Key Laboratory of Visual Impairment, Restoration of Shanghai and Key Laboratory of Myopia of State Health Ministry, Fudan University, Shanghai 200031, China
| | - Ge-Zhi Xu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai 200031, China.,Key Laboratory of Visual Impairment, Restoration of Shanghai and Key Laboratory of Myopia of State Health Ministry, Fudan University, Shanghai 200031, China
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Haas AM, Stattin M, Ahmed D, Krebs I, Ansari-Shahrezaei S. Development of Secondary Choroidal Neovascularization in Focal Choroidal Excavation of Punctate Inner Choroidopathy. Ocul Immunol Inflamm 2018; 28:20-25. [PMID: 30422049 DOI: 10.1080/09273948.2018.1540708] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To elaborate a case of focal choroidal excavation (FCE) in punctate inner choroidopathy (PIC) complicated by secondary choroidal neovascularization (CNV) based on multimodal imaging findings.Methods: In this retrospective case report, multimodal imaging including near-infrared reflectance, blue peak autofluorescence, spectral domain-optical coherence tomography (OCT), fluorescein and indocyanine green angiography (Heidelberg Engineering GmbH, Germany), and swept source-OCT angiography (SS-OCTA; Topcon Corporation, Japan) was performed.Patients: A 27-year-old moderate myopic woman presented with inactive CNV of unknown origin in her left eye, which had been previously treated with intravitreal anti-vascular endothelial growth factor.Results: Multimodal imaging revealed PIC as the causative disease and systemic corticosteroids were administered. Similar complaints 13 months later showed new CNV formation at the already documented FCE. No sign of PIC could be detected at follow-up.Conclusion: This well-documented case highlighted FCE as the preferential location for CNV development in PIC with multimodal imaging emphasizing a chorioretinal entity.Summary: This case report demonstrated the clinical course of focal choroidal excavation in a patient initially diagnosed with punctate inner choroidopathy complicated by choroidal neovascularization and its treatment response, well documented by multimodal imaging including optical coherence tomography angiography.
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Affiliation(s)
- Anna-Maria Haas
- Department of Ophthalmology, Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria
| | - Martin Stattin
- Department of Ophthalmology, Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria.,Department of Ophthalmology, Rudolf Foundation Hospital, Vienna, Austria
| | - Daniel Ahmed
- Department of Ophthalmology, Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria.,Department of Ophthalmology, Rudolf Foundation Hospital, Vienna, Austria
| | - Ilse Krebs
- Department of Ophthalmology, Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria.,Department of Ophthalmology, Rudolf Foundation Hospital, Vienna, Austria
| | - Siamak Ansari-Shahrezaei
- Department of Ophthalmology, Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria.,Department of Ophthalmology, Rudolf Foundation Hospital, Vienna, Austria.,Department of Ophthalmology, Medical University of Graz, Graz, Austria
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22
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Liu GH, Lin B, Sun XQ, He ZF, Li JR, Zhou R, Liu XL. Focal choroidal excavation: a preliminary interpretation based on clinic and review. Int J Ophthalmol 2015; 8:513-21. [PMID: 26086000 DOI: 10.3980/j.issn.2222-3959.2015.03.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 11/18/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To describe the clinical and imaging characteristics associated with focal choroidal excavation (FCE), analyze the possible complication, and interpret its probable etiopathogenesis. METHODS Retrospective descriptive case series of 37 eyes of 32 patients with FCE. Findings of spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography, indocyanine green angiography, and clinical features were analyzed. RESULTS All patients were Chinese. Five patients (15.6%) were bilaterally involved. Patients' ages ranged from 7 to 66y. Refractive error ranged between +2.0 D and -11.0 D. Mean best-corrected visual acuity was 0.6 (range, 0.1 to 1.2). Fundus examinations exhibited mild-moderate localized pigmentary disturbances in the corresponding area of 17 eyes. Fluorescein angiography performed in 18 patients showed varying degrees of hyperfluorescence and hypofluorescence related to a range of retinal pigment epithelium (RPE) alterations. Indocyanine green angiography performed in 7 patients showed hypofluorescence at the excavation. SD-OCT demonstrated choroidal excavation in all 37 eyes. Twenty-nine eyes showed a single lesion of FCE, and three eyes showed 2-3 separated lesions. Fifteen eyes showed separation between the photoreceptor tips and RPE consistent with nonconforming FCE. Central serous chorioretinopathy (CSC, n=1) and choroidal neovascularization (CNV, n=1) developed during follow-up. CONCLUSION FCE could be interpreted as congenital focal choroidal dysplasia involving the RPE, choriocapillaris, and photoreceptor associated with the faulty anatomy. The abnormal anatomy of FCE was similar to anatomy at risk of CSC and CNV.
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Affiliation(s)
- Guang-Hui Liu
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China ; Department of Ophthalmology, Affiliated People's Hospital to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian Province, China
| | - Bing Lin
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Xin-Quan Sun
- Department of Ophthalmology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Zi-Fang He
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Ji-Rong Li
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Rong Zhou
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Xiao-Ling Liu
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
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23
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Abstract
We describe focal choroidal excavation (FCE) in a case of Vogt–Koyanagi–Harada (VKH) disease and compare the findings with different chorioretinal conditions. A 55-year-old man was diagnosed with VKH based on panuveitis and exudative retinal detachments. Spectral-domain optical coherence tomography demonstrated a dome-shaped protrusion with a nonconforming pattern at the fovea, which had been detected as a conforming pattern 1 year before the onset. The FCE pattern returned into a conforming pattern following corticosteroid therapy. These findings suggest that the natively existent FCE could be affected by pathophysiological changes of VKH as well as other chorioretinal conditions.
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Affiliation(s)
- Yuko Nishikawa
- Department of Ophthalmology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan ; Laboratory of Visual Physiology, National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, Japan ; Department of Ophthalmology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Kaoru Fujinami
- Department of Ophthalmology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan ; Laboratory of Visual Physiology, National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, Japan ; Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan ; UCL Institute of Ophthalmology, London, UK
| | - Ken Watanabe
- Department of Ophthalmology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan ; Laboratory of Visual Physiology, National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, Japan
| | - Toru Noda
- Department of Ophthalmology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan ; Laboratory of Visual Physiology, National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, Japan
| | - Kazushige Tsunoda
- Department of Ophthalmology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan ; Laboratory of Visual Physiology, National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, Japan
| | - Kunihiko Akiyama
- Department of Ophthalmology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan ; Laboratory of Visual Physiology, National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, Japan
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