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FOCAL CHOROIDAL EXCAVATION AND ITS ASSOCIATION WITH PACHYCHOROID SPECTRUM DISORDERS: A Review of the Literature and Multimodal Imaging Findings

Chung, Hyewon MD, PhD; Byeon, Suk Ho MD, PhD; Freund, K. Bailey MD

doi: 10.1097/IAE.0000000000001345
Review
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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.

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.

*Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea;

Vitreous Retina Macula Consultants of New York, New York, New York;

Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea;

§The LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; and

Department of Ophthalmology, New York University Medical School, New York, New York.

Reprint requests: K. Bailey Freund, MD, Vitreous Retina Macula Consultants of New York, 460 Park Avenue, Fifth floor, New York, NY 10022; e-mail: kbfnyf@aol.com

Supported by the Macula Foundation, Inc, New York, NY and was written as part of Konkuk University's research support program for its faculty on sabbatical leave in 2015.

K. B. Freund is a consultant for Genentech, Optovue, Optos, Bayer Healthcare, and Heidelberg Engineering. The remaining authors have no financial/conflicting interests to disclose.

© 2017 by Ophthalmic Communications Society, Inc.