title: Observed positive correlation between Epstein-Barr virus infection and focal choroidal excavation.
abstract: OBJECTIVE
  To evaluate a possible correlation between focal choroidal excavation and Epstein-Barr virus (EBV) infection.
  
  
  METHODS
  Three eyes of three patients underwent a comprehensive ophthalmologic examination including visual field testing, color fundus photography, optical coherence tomography (OCT), fluorescein angiography and indocyanine green angiography. In addition, hematological and viral infectivity were also evaluated.
  
  
  METHODS
  Two females and one male with a mean age of 53.6 ± 5.6 years were studied.
  
  
  RESULTS
  In all patients, both the anterior and posterior segment evaluations were unremarkable except for the presence of a spot with focal retinal pigment epithelium (RPE) alteration. In patients 1 and 2, OCT disclosed a normal neuroretinal structure above the lesion and a focal 'punch-out' choroidal lesion with total absence of the RPE coupled with a localized hyporeflectivity in the subretinal space. In two of the three patients, OCT showed normal outer retinal layers, including the photoreceptor layer and the external limiting membrane with a hyporeflective space under the inner segment/outer segment (IS/OS) junction. In one patient, the retinal structure appeared to descend down into the choroidal excavation with an absence of the IS/OS junction and RPE. Moreover, the outer retinal layers appeared to be deformed. In all three patients, the choriocapillaris and choroid showed significant defects as if 'punched out' and the scleral boundary was more evident. In all three patients, an active EBV infection was confirmed by hematological investigation.
  
  
  CONCLUSIONS
  In all our patients with focal choroid anomalies, such as choroidal excavation observed by OCT, a systemic infection by the EBV was detected. A larger number of similar cases are necessary to corroborate these preliminary observations.
authors.affiliation: Department of Ophthalmology, Catholic University "Sacro Cuore - A. Gemelli", Largo A. Gemelli, 8, 00168, Rome, Italy, crisav8@virgilio.it.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Savastano
authors.forename: Marco
authors.initials: M
authors.lastname: Rispoli
authors.forename: Luca
authors.initials: L
authors.lastname: Di Antonio
authors.forename: Leonardo
authors.initials: L
authors.lastname: Mastropasqua
authors.forename: Bruno
authors.initials: B
authors.lastname: Lumbroso
mesh_terms: D015862:Choroid Diseases / Q000473:pathology / Q000821:virology*; D003587:Cytomegalovirus / Q000302:isolation & purification; D020031:Epstein-Barr Virus Infections / Q000473:pathology*; D015828:Eye Infections, Viral / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055213:Retinal Pigment Epithelium / Q000473:pathology; D041623:Tomography, Optical Coherence; D014792:Visual Acuity