Clinical and spectral-domain optical coherence tomography findings in patients with focal choroidal excavation.
OBJECTIVE
To describe the clinical and spectral-domain optical coherence tomography (SD-OCT) findings in patients with focal choroidal excavation (FCE).


METHODS
Retrospective case series.


METHODS
Forty-one eyes of 38 patients with FCE identified in 2 tertiary medical centers in Korea.


METHODS
Clinical features, SD-OCT findings, and associated macular disorders of FCE were analyzed and detailed.


METHODS
Statistical associations among clinical features, including lesion type, size, and choroidal thickness, and frequency of association with central serous chorioretinopathy (CSC), choroidal neovascularization (CNV), and polypoidal choroidal vasculopathy (PCV).


RESULTS
Mean patient age was 50.1 years (range, 25-76 years). The mean spherical equivalent of refractive error was -3.7 diopters (range, -10.0 to +1.5 diopters). Three patients (8%) had bilateral lesions, and 1 patient (3%) had 2 distinct lesions in the same eye. The mean FCE width and depth were 757 μm and 107 μm, respectively, with a positive correlation between width and depth (P = 0.003). The mean subfoveal choroidal thickness of FCE eyes was 284 μm, which was not statistically different from that of age-, sex-, and refractive error-matched normal subjects. Choroidal thickness in FCE was less in eyes with hyperreflective choroidal tissue under the excavation that was present in 22 eyes (54%) versus eyes without excavation (128 vs. 190 μm, respectively; P = 0.009). Twelve FCEs (29%) were the nonconforming type, revealing separation between the photoreceptor tips and the retinal pigment epithelium on SD-OCT. Nonconforming FCE was associated with visual symptoms (P < 0.001) and the presence of concurrent CSC (P = 0.001). Ten eyes (24%) were associated with CSC, and 9 eyes (22%) were associated with CNV, including 1 eye with PCV features. One eye with FCE and type 1 CNV developed a new excavation, and the excavated area in 1 eye with PCV enlarged slightly during follow-up.


CONCLUSIONS
Focal choroidal excavation is a relatively common entity and frequently associated with choroidal diseases, including CSC, CNV, and PCV. Although FCE is classically thought to be a congenital malformation, acquired FCE forms possibly exist.
The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Shinchon Severance Hospital, Seoul, Korea. Electronic address: sklee219@yuhs.ac.
Christopher Seungkyu
CS
Lee
Department of Ophthalmology Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Se Joon
SJ
Woo
Department of Ophthalmology Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Yong-Kyu
YK
Kim
Department of Ophthalmology Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Ophthalmology, HanGil Eye Hospital, Incheon, Korea.
Duck Jin
DJ
Hwang
The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Shinchon Severance Hospital, Seoul, Korea.
Hae Min
HM
Kang
The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Shinchon Severance Hospital, Seoul, Korea.
Hyesun
H
Kim
The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Shinchon Severance Hospital, Seoul, Korea.
Sung Chul
SC
Lee
D000328:Adult; D000368:Aged; D056833:Central Serous Chorioretinopathy / Q000175:diagnosis; D002829:Choroid / Q000002:abnormalities* / Q000473:pathology; D015862:Choroid Diseases / Q000175:diagnosis*; D020256:Choroidal Neovascularization / Q000175:diagnosis; D004396:Coloring Agents; D005124:Eye Abnormalities / Q000175:diagnosis*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011127:Polyps / Q000175:diagnosis; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology
D004396:Coloring Agents; D007208:Indocyanine Green