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PHOTO ESSAY
Year : 2016  |  Volume : 28  |  Issue : 3  |  Page : 213-214

Focal choroidal excavation associated with choroidal neovascular membrane


Department of Vitreoretina Services, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India

Date of Web Publication2-May-2017

Correspondence Address:
Vanee Sheth Shah
Aravind Eye Hospital, Coimbatore - 641 014, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kjo.kjo_28_17

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How to cite this article:
Shah VS, Manayath G, Narendran V. Focal choroidal excavation associated with choroidal neovascular membrane. Kerala J Ophthalmol 2016;28:213-4

How to cite this URL:
Shah VS, Manayath G, Narendran V. Focal choroidal excavation associated with choroidal neovascular membrane. Kerala J Ophthalmol [serial online] 2016 [cited 2021 May 6];28:213-4. Available from: http://www.kjophthal.com/text.asp?2016/28/3/213/205428

A 51-year-old male presented with metamorphopsia in the left eye for the past 15 days. On investigation, he was noted to have a focal choroidal excavation (FCE) in the left eye associated with a choroidal neovascular (CNV) membrane overlying a thickened choroid.

FCE is a relatively new entity described as an area of macular choroidal excavation detected on spectral domain-optical coherence tomography scan without evidence of posterior staphyloma or scleral ectasia, in a patient lacking a history of trauma, retinal or choroidal vascular disease, or any infection. Several case series have reported FCE in eyes with CNV associated with age-related macular degeneration, polypoidal choroidal vasculopathy, and central serous chorioretinopathy.[1],[2] It is seen in asymptomatic individuals as well. Whether it is the cause or the effect is still unproven. It is postulated that excavation affects structure of retinal pigment epithelium (RPE) and choroidal layers causing ischemia leading to CNV.[3] It is also theorized that focal scarring of choroid tissue in cases with CNV may cause RPE retraction and hence excavation.[4] As some cases are shown to be associated with a pachychoroid, the collapse of a pachyvessel is another proposed mechanism for the development of excavation.[5] Hence, it is important for ophthalmologists to understand this entity and to follow up patients with FCE regularly, for occurrence of such treatable complications.

[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6] show the clinical, autofluorescence, optical coherence tomography and the fundus fluorescein angiography images of the focal choroidal excavation and the associated choroidal neovascular membrane.
Figure 1: Color fundus picture of left eye showing choroidal neovascular membrane nasal to fovea

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Figure 2: Fundus autofluorescence image showing hypoautofluorescence just nasal to fovea corresponding to focal choroidal excavation with hyperautofluorescence corresponding to choroidal neovascular membrane

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Figure 3: Spectral domain-optical coherence tomography image of the left eye showing a choroidal neovascular membrane with subretinal fluid and focal choroidal excavation

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Figure 4: Enhanced depth imaging optical coherence tomography of the left eye showing a choroidal neovascular membrane associated with focal choroidal excavation with subretinal fluid overlying a thickened choroid (subfoveal choroidal thickness of 310 μm)

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Figure 5: Fundus fluorescein angiography images of the early phase showing a classic type of choroidal neovascular membrane

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Figure 6: Fundus fluorescein angiography images of the late phase showing an active classic type of choroidal neovascular membrane

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Lim FP, Wong CW, Loh BK, Chan CM, Yeo I, Lee SY, et al. Prevalence and clinical correlates of focal choroidal excavation in eyes with age-related macular degeneration, polypoidal choroidal vasculopathy and central serous chorioretinopathy. Br J Ophthalmol 2016;100:918-23.  Back to cited text no. 1
    
2.
Liu GH, Lin B, Sun XQ, He ZF, Li JR, Zhou R, et al. Focal choroidal excavation: A preliminary interpretation based on clinic and review. Int J Ophthalmol 2015;8:513-21.  Back to cited text no. 2
    
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.  Back to cited text no. 3
    
4.
Kobayashi W, Abe T, Tamai H, Nakazawa T. Choroidal excavation with polypoidal choroidal vasculopathy: A case report. Clin Ophthalmol 2012;6:1373-6.  Back to cited text no. 4
    
5.
Say EA, Jani PD, Appenzeller MF, Houghton OM. Focal choroidal excavation associated with polypoidal choroidal vasculopathy. Ophthalmic Surg Lasers Imaging Retina 2013;44:409-11.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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