Fluography of choroidal folds

Abstract

Folding of the pigment epithelium and the choroid, although clearly visible in the fluogram, often cannot be visualized by ophthalmoscopy or by conventional photography, so that it can be said that fluography has disclosed this entity. Its occurrence has been described in deformation of the coats of the eye by a retrobulbar mass, hypermetropia, chronic retrobulbar inflammations, and choroidal tumours.In the present series, which contains material from five eye clinics, cases are demonstrated of choroidal folds in papilloedema caused by raised intracranial pressure, and in macular degeneration.These last cases have given rise to a hypothetical genesis of these folds, namely by the combination of retinal displacement and the presence of subretinal fluid.Fluorescein angiography of the fundus (fluography) can reveal structures which are difficult or impossible to set by other methods. A good example of this are the folds of the pigment epithelium and choroid to be described here. A number of such cases have been described recently (Table II).

Hypotony maculopathy

“…Several authors have subsequently confirmed that any condition causing a reduction in the area of the inner surface of the sclera (scleral thickening or scleral shrinkage) may cause the inner portion of the choroids, the overlying retinal pigment epithelium and the outer retinal layers to be thrown into a series of folds or wrinkles (Dellaporta 1950; Norton 1969; Hyvarinen & Walsh 1970; Kroll & Norton 1970; François & DeLaey 1971; Von Winning 1972; Newell 1973; Cangemi et al. 1978; Kalina & Mills 1980; Morris & Sanders 1980; Lebuisson et al.…”

Clinical Observations Concerning Choroidal Folds

“…Choroidal folds can be most accurately identified on the basis of their typical fluo rescein angiographical appearance [2,6,8,11,14,17]. In the early arterial phase they have the appearance of strongly contrasting dark and light bands (see figures 4 and 6).…”

“…In no phase of the fluorescein angiogram is there evidence of a release of dye. According to von Winning [17], the fluorescein absorp tion in the valleys of the choroidal folds can be explained by a compression of the pig- This case selection is purely incidental. In other publications on this subject, the distribution of male and female patients within each group investigated is more or less equal.…”

“…In many cases, moreover, the folds were character ized as idiopathic [8,14], Before the era of fluorescein angiography, most discussions in the literature made no distinction between retinal and chorioreti nal folds [7,16]. It was in fluorescein angio grams that the typical appearance of each made it at last possible to distinguish the symptom of 'choroidal folds' from retinal folds [6,12,17], The diagnosis 'choroidal folds'should, as a matter of principle, always serve as a reason for eliminating all diseases which could possibly come into question as the source of these folds; in this manner, both orbital and choroidal tumors, respec tively, can be subjected to a corresponding therapy, when the choroidal folds are recog nized at an early date.…”

Aetiology and management of choroidal folds

“…The slit should be perpendicular to the folds for easiest visualisation. 3 The appearance of folds may be accentu-ated by red-free viewing or photography. 4 Fluorescein angiography demonstrates more severe fundus changes than are evident with light ophthalmoscopy (Figure 1).…”