Focal choroidal excavation linked to chorioretinal diseases

By Nikki Withers, medwireNews Reporter

Results of a Japanese study show that focal choroidal excavation (FCE) is present in several ocular diseases, including typical age-related macular degeneration (t-AMD), central serous chorioretinopathy (CSC), polypoidal choroidal vasculopathy (PCV) and idiopathic choroidal neovascularization (ICNV).

Writing in Retina, the researchers explain that little is currently known about the etiology of FCE. They therefore decided to investigate any clinically relevant morphologic findings in patients with FCE using enhanced depth imaging optical coherence tomography (ED-OCT).

In all, 31 FCE lesions in 29 eyes of 26 patients (21 men, 23 eyes; five women, six eyes) were included in the study. The mean age of the patients was 58.7 years.

Colour fundus photographs were obtained for all patients and fluorescein angiography and indocyanine green angiography with simultaneous ED-OCT were performed. Twenty-five eyes also underwent angiographic video recording.

Led by Akiyuki Kawamura, from Surugadai Hospital of Nihon University in Tokyo, Japan, the researchers classified FCE lesions into three types: cone-shaped, bowl-shaped and mixed.

They report that the cone-shaped type was detected in 17 lesions, the bowl-shaped in eight, and the mixed type in six. All bowl-shaped and mixed types had retinal pigment epithelial (RPE) irregularities within the FCE lesion.

The researchers confirmed the presence of FCE in various ocular diseases, including t-AMD, CSC, PCV and ICNV. However, they note that some eyes were considered to have idiopathic FCE.

Interestingly, the cone-shaped type was not observed in eyes with t-AMD. The authors explain that this type of FCE appeared to be tethered to other structures, had an essentially smooth RPE on OCT and showed less atrophic change at the centre compared with the other two types.

Assessment of choroidal thickness revealed that the minimum thickness at the deepest point of FCE was an average of 176.4 µm and the average maximum choroidal thickness of the tissue adjacent to the FCE was 304.3 µm. The thickness varied in every type or disease of FCE, notes the team.

The authors now plan to use swept source-OCT to study the border between the choroid and the sclera. “Further study is also needed to determine the etiology of FCE”, they conclude.

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