Optical Coherence Tomography Angiography Features of Focal Choroidal Excavation and the Choroidal Stroma Variations With Occurrence of Excavation

Abstract

Purpose: To describe retinal and choroidal vascular changes, and choroidal stroma variations occurring in focal choroidal excavation (FCE). Methods: Study design was a cross-sectional case series. Consecutive patients affected by FCE and healthy controls were recruited. All patients underwent complete ophthalmologic assessment and multimodal imaging, including structural optical coherence tomography and optical coherence tomography angiography. Choroidal thickness and stromal index were calculated from structural optical coherence tomography images. Moreover, we measured vessel density values of the superficial capillary plexus, deep capillary plexus and choriocapillaris at the level of the macula. Results: Twenty-two patients (28 eyes; mean age 57.2 ± 16.4) and 28 control eyes (mean age of 56.5 ± 9.8) were included. Five patients (23%) were asymptomatic, whereas 17 patients (77%) complained of visual symptoms. FCE was associated with choroidal neovascularization in 10 eyes (35%). Choroidal stromal component was lower in FCE patients than controls, whereas choroidal thickness was unremarkable. Stromal index values calculated in the region proximal to the FCE was significantly lower than the values obtained from the external region. Deep capillary plexus vessel density was lower in FCE than controls. Choriocapillaris was altered in the region surrounding the FCE, whereas it was normal in the external region. Conclusion: Deep capillary plexus and choriocapillaris plexus were significantly altered in FCE patients. Moreover, choroidal stroma was significantly reduced in the areas closer to FCE compared to the surrounding choroid in patients, as well as compared to healthy controls, suggesting the hypothesis of weakening of the architectural support, creating a more friable point, which can favor FCE development.

Correlation Between Focal Choroidal Excavation and Underlying Retinochoroidal Disease

“…Lee et al 12 reported 16 eyes with CNV and FCE, among which all CNV either lay within the boundary or extended over the margin of FCE. Rajabia et al 13 analyzed the retinal and choroidal vascular changes and choroidal stroma variations occurring in FCE; they found that deep capillary plexus and CC plexus rarefaction along with a decrease in perfusion in the region surrounding the FCE may potentially trigger CNV development.…”

Large choroidal excavation in myopic macular degeneration: A case report

“…A recent pathogenic hypothesis comprises a localized lack of the choroidal stroma causing a weakening of the choroidal bulking leading to the onset of the excavation. 9 Based on our findings, showing a prevalent retinal and choroidal involvement with just a small scleral thinning limited to the relatively narrow area of the choroidal excavation, we reported a rare case of LCE without myopiarelated staphyloma. The reported cases of LCE were mainly detected in retinal diseases characterized by a strong inflammatory component.…”

Sequência dos tipos de escavação focal de coroide em um paciente com coriorretinopatia serosa central bilateral

“…OCT angiography would provide additional data, such as analysis of the retinal and choroidal vascular plexus. (13) However, in this case, the performed multimodal imaging analysis (FA, OCT, and ICGA) allowed the characterization of pachychoroid spectrum disease-associated abnormalities.…”

“…Other important clinical manifestations of the pachychoroid spectrum disease, besides FCE and CSC, are pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy/aneurysmal type 1 neovascularization, and peripapillary pachychoroid syndrome (11) . In addition to FA and ICGA, other imaging features allow better characterization of the FCE: i) optical coherence tomography (OCT) may reveal high hyperreflective choroidal thinning in the area of the FCE, a separation or attachment between photoreceptors and the retinal pigment epithelium (RPE), and absence of abnormalities of the underlying sclera (11) ; ii) swept-source, enhanced depth imaging, and three-dimensional OCT can improve choroid and sclera analysis (2,4,12) ; iii) OCT angiography may demonstrate alteration of the deep capillary and choriocapillaris plexus (13) .…”