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| PHOTO ESSAY |
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| Year : 2022 | Volume
: 2
| Issue : 2 | Page : 594 |
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Focal choroidal excavation
Arthi Mohankumar, Manoj Khatri
Department of Retina and Vitreous, Rajan Eye Care Hospital, Chennai, Tamil Nadu, India
| Date of Submission | 28-Sep-2021 |
| Date of Acceptance | 12-Oct-2021 |
| Date of Web Publication | 13-Apr-2022 |
Correspondence Address:
Arthi Mohankumar
Rajan Eye Care Hospital, T Nagar, Chennai, Tamil Nadu - 600 017
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijo.IJO_2520_21
Keywords: Choroidal cavitary disorders, focal choroidal excavation, pachychoroid
How to cite this article:
Mohankumar A, Khatri M. Focal choroidal excavation. Indian J Ophthalmol Case Rep 2022;2:594 |
A 52-year-old male presented to us for routine examination. His best-corrected visual acuity (BCVA) was 6/6 in both eyes. Fundus examination of the right eye was normal. The left eye showed an oval, excavated hyperpigmented lesion temporal to the fovea. Optical coherence tomography (OCT) through the lesion showed concavity of the choroid with separation between the photoreceptor tips and retinal pigment epithelium (RPE) [Figure 1]. Fundus autofluorescence showed hypo autofluorescence corresponding to the lesion. The patient was diagnosed to have juxtafoveal primary non-conforming type of Focal choroidal excavation (FCE) and observed. | Figure 1: (a) color fundus photography of the left eye showing a pigmented lesion temporal to fovea indicated by the red arrow. (b) Optical coherence tomography scan through the lesion showing a cone-shaped nonconforming type of FCE indicated by the white arrow
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| Discussion | |  |
FCE was first described by Jampol et al. in 2006 in an asymptomatic myope.[1],[2] It is classified as conforming type when there is no separation between photoreceptor and RPE and non-conforming type when there is separation, which is seen as a hyporeflective space.[3] This space may be occupied by subretinal fluid, vitelliform material, or hyperreflective scar tissue. It can convert from conforming to nonconforming type and vice versa spontaneously or with treatment of the associated pathologies. Based on the shape, they can be classified as cone-shaped, bowl-shaped, or mixed morphology when they have features of both. Congenital/primary FCE occurs mostly in myopes in absence of other pathologies. Acquired/secondary FCE may be associated with pachychoroid diseases, chorioretinal inflammation, dystrophies, and tumors.[4] There is no classical fundus finding attributable, and diagnosis is mainly based on OCT, which helps us differentiate from other choroidal cavitary disorders such as intrachoroidal cavitation and torpedo maculopathy. Lesions that may mimic FCE include traumatic choroidal ruptures, choroidal vascular disorders, and staphylomas when associated with focal areas of choroidal thinning. Management includes excluding associated pathologies and their specific treatment if present. FCE alone can be observed due to their stationary nature but needs regular follow-up due to the increased incidence of choroidal neovascularization.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Nassar S, Tarbett AK, Browning DJ. Choroidal cavitary disorders. Clin Ophthalmol 2020;14:2609-23.  |
| 2. | Kumano Y, Nagai H, Enaida H, Ueno A, Matsui T. Symptomatic and morphological differences between choroidal excavations. Optom Vis Sci 2013;90:e110-8. |
| 3. | Margolis R, Mukkamala SK, Jampol LM, Spaide RF, Ober MD, Sorenson JA, et al. The expanded spectrum of focal choroidal excavation. Arch Ophthalmol 2011;129:1320-5. |
| 4. | Verma S, Kumar V, Azad S, Bhayana AA, Surve A, Kumar S, et al. Focal choroidal excavation: Review of literature. Br J Ophthalmol 2021;105:1043-8. |
[Figure 1]
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