FOCAL CHOROIDAL EXCAVATION AND ITS ASSOCIATION WITH PACHYCHOROID SPECTRUM DISORDERS

A Review of the Literature and Multimodal Imaging Findings

Abstract

Purpose: 

To review the literature regarding focal choroidal excavation and show its association with pachychoroid features through case examples.

Methods: 

The clinical manifestations of focal choroidal excavation are illustrated with various imaging modalities inclusive of fundus photography, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, spectral domain optical coherence tomography (OCT), enhanced depth imaging OCT, and swept-source OCT.

Results: 

Diffuse or focal areas of choroidal thickening with dilated choroidal vessels (pachyvessels) on OCT and choroidal hyperpermeability on indocyanine green angiography are present in many eyes with focal choroidal excavation. Clinical and imaging features of associated comorbidities including central serous chorioretinopathy and choroidal neovascularization are described.

Conclusion: 

Focal choroidal excavation appears to be a manifestation of pachychoroid spectrum disease associated with choroidal thickening and pachyvessels on structural OCT and choroidal hyperpermeability on indocyanine green angiography.

In Brief

Dilated choroidal vessels, increased choroidal thickness, and choroidal hyperpermeability are demonstrated in a series of eyes with focal choroidal excavation. The pachychoroid phenotype seems to be associated with focal choroidal excavation. Patients with focal choroidal excavation are at risk for vision-threatening complications including central serous chorioretinopathy and choroidal neovascularization.