Clinical and Spectral-Domain Optical Coherence Tomography Findings in Patients with Focal Choroidal Excavation

Objective: To describe the clinical and spectral-domain optical coherence tomography (SD-OCT) findings in patients with focal choroidal excavation (FCE). Design: Retrospective case series. Participants: Forty-one eyes of 38 patients with FCE identified in 2 tertiary medical centers in Korea. Methods: Clinical features, SD-OCT findings, and associated macular disorders of FCE were analyzed and detailed. Main Outcome Measures: Statistical associations among clinical features, including lesion type, size, and choroidal thickness, and frequency of association with central serous chorioretinopathy (CSC), choroidal neovascularization (CNV), and polypoidal choroidal vasculopathy (PCV). Results: Mean patient age was 50.1 years (range, 25-76 years). The mean spherical equivalent of refractive error was -3.7 diopters (range, -10.0 to +1.5 diopters). Three patients (8%) had bilateral lesions, and 1 patient (3%) had 2 distinct lesions in the same eye. The mean FCE width and depth were 757 mm and 107 mm, respectively, with a positive correlation between width and depth (P = 0.003). The mean subfoveal choroidal thickness of FCE eyes was 284 mm, which was not statistically different from that of age-, sex-, and refractive error-matched normal subjects. Choroidal thickness in FCE was less in eyes with hyperreflective choroidal tissue under the excavation that was present in 22 eyes (54%) versus eyes without excavation (128 vs. 190 mm, respectively; P = 0.009). Twelve FCEs (29%) were the nonconforming type, revealing separation between the photoreceptor tips and the retinal pigment epithelium on SD-OCT. Nonconforming FCE was associated with visual symptoms (P < 0.001) and the presence of concurrent CSC (P < 0.001). Ten eyes (24%) were associated with CSC, and 9 eyes (22%) were associated with CNV, including 1 eye with PCV features. One eye with FCE and type 1 CNV developed a new excavation, and the excavated area in 1 eye with PCV enlarged slightly during follow-up. Conclusions: Focal choroidal excavation is a relatively common entity and frequently associated with choroidal diseases, including CSC, CNV, andPCV. Although FCE is classically thought to be a congenital malformation, acquired FCE forms possibly exist. (C) 2014 by the American Academy of Ophthalmology.