title: Acquired focal choroidal excavation associated with multiple evanescent white dot syndrome: observations at onset and a pathogenic hypothesis.
abstract: BACKGROUND
  The mechanism underlying focal choroidal excavation (FCE) remains largely unknown. We evaluated the sequential progression of FCE generation using enhanced depth imaging optical coherence tomography (EDI-OCT) in a patient with multiple evanescent white dot syndrome (MEWDS).
  
  
  METHODS
  A 37-year-old woman suffered MEWDS in the right eye. EDI-OCT showed the loss of photoreceptor inner segment/outer segment junction line, detachment between the retinal pigment epithelium (RPE) and Bruch's membrane, and dome-shaped, moderately reflective, focal photoreceptor-layer lesions corresponding to perifoveal white dots. The region with pigment epithelium detachment involved RPE/Bruch's membrane ruptures. After 1 month, almost all white dots spontaneously resolved together with improvements of the perifoveal OCT findings. Interestingly, perifoveal region developed a conforming-type FCE. An abnormal hyper-reflective lesion on OCT, regarded as fibrosis formation, simultaneously appeared within the choroid below the FCE and subsequently increased in size.
  
  
  CONCLUSIONS
  These results suggest that the RPE/Bruch's membrane disruption due to chorioretinal abnormalities and subsequent intrachoroidal scar formation play a role in the pathogenesis on an acquired FCE.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Hashimoto
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. wsaito@med.hokudai.ac.jp.
authors.forename: Wataru
authors.initials: W
authors.lastname: Saito
authors.forename: Kousuke
authors.initials: K
authors.lastname: Noda
authors.forename: Susumu
authors.initials: S
authors.lastname: Ishida
mesh_terms: D000328:Adult; D016570:Bruch Membrane / Q000473:pathology*; D015862:Choroid Diseases / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D012164:Retinal Diseases / Q000150:complications* / Q000175:diagnosis; D055211:Retinal Photoreceptor Cell Inner Segment / Q000473:pathology*; D055214:Retinal Photoreceptor Cell Outer Segment / Q000473:pathology*; D055213:Retinal Pigment Epithelium / Q000473:pathology*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity