Development of Focal Choroidal Excavation in the Presence of Pachychoroid

Introduction

Focal choroidal excavation (FCE) is a structural abnormality of unknown origin first described by Jampol et al. [1] in 2006. FCE is defined as an area of concavity in the choroid, mostly in the macula and rarely in the extra-macular region. FCE is detected by optical coherence tomography (OCT) without accompanying scleral ectasia or posterior staphyloma [1], [2]. Mostly diagnosed in the fourth or fifth decade, it is nonprogressive, unilateral, and has no sex predilection [1], [2]. A literature review suggested an association with myopia [1], [2]. Usually, not vision threatening, diminution of vision may occur due to an associated pathology or subfoveal location of the lesion. Although initially considered congenital, an increasing number of cases have been reported in association with other retinochoroidal pathologies, such as central serous chorioretinopathy (CSC), choroidal neovascularization (CNV), polypoidal choroidal vasculopathy (PCV), choroiditis, and choroidal tumors [2]. Margolis et al. [3] classified FCE into conforming and nonconforming types based on whether a subretinal space between the photoreceptor tips and the retinal pigment epithelium (RPE) could be observed on OCT. In conforming FCE, there is no separation between the photoreceptor tips and the RPE, with the outer nuclear layer appearing thicker than it does in areas not affected by excavation [3]. In this type of excavation, the ellipsoid zone and RPE are undisturbed. On the other hand, in nonconforming FCE, the photoreceptor tips appear to be detached from the underlying RPE, with the intervening hyporeflective space presumably representing subretinal fluid [3]. In these eyes, the signals corresponding to the RPE and the ellipsoid zone are often disrupted. Hyperreflective material, presumed to represent shed outer segment debris, is often present below an intact external limiting membrane [3].

Because most published studies are cross-sectional, the natural course of FCE remains to be discovered. Only a few studies with longitudinal follow-up data are available, and most excavations remain stable during follow-up [2], [4], [5]. Here, we present the case of a 37-year-old man with FCE that progressed during the more than 7-year follow-up period.

Publication History

Received: 09 August 2023

Accepted: 07 April 2024

Accepted Manuscript online:
10 April 2024

Article published online:
26 April 2024

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