The origin of choroidal folds a clinical, histopathological, and experimental study

Abstract

Choroidal folds were defined as folds in Bruch's membrane and the anterior choroid. A clinical, histopathological and experimental investigation was performed.Eleven cases with choroidal folds were described. These cases included exophthalmos (from lymphoid hyperplasia, thyroid disease, orbital cellulitis, post-operative swelling, and orbital hemangioma), scleritis, retinal detachment due to metastatic lung carcinoma, hypotony, papilledema and choroidal detachment.The histology of 80 unselected enucleated eyes was examined and choroidal folds were found in 23 (29%). The most common cause was choroidal thickening due to vascular engorgement, hemorrhage or inflammation. Folds were also formed by tissue compression at the edge of a choroidal tumor or scleral implant, or by scleral thickening.Choroidal folds were produced in vivo in cat's eyes by traction on the optic nerve or by hypotony after paracentesis. The irregular folds after hypotony could be oriented by traction on the optic nerve.It was hypothesized that choroidal folds are produced by any mechanism which forces Bruch's membrane to fold, and that traction on the optic nerve may play a role in the characteristic horizontal temporal orientation of choroidal folds seen in many patients.

Retinal Microvascular Abnormalities in Patients Treated With External Radiation for Graves Ophthalmopathy

“…Other fundus abnormalities seen with Graves ophthalmopathy include the presence of choroidal folds, which may occur unilaterally or bilaterally [14][15][16] ; none of the eyes in this study had clinically recognized choroidal folds, nor were any folds recognized with the fluorescein angiograms. One would not expect choroidal folds to be associated with abnormal retinal vessels.…”

Retinal and Choroidal Folds in Papilledema

“…31,[40][41][42] Previous authors have speculated that choroidal folds are the result of the anterior deformation of the load bearing structures of the optic nerve head. 11,15,43 In 1974, Bullock and Egbert 44,45 showed that temporal tensile traction on the optic nerve in vivo generates horizontal choroidal-retinal folds nasal to the optic disc, an effect that was exaggerated by decreasing the intraocular pressure. They also showed that manual compression of the RPE/Bruch's membrane in cadaver eyes generates folds perpendicular to the axis of compression.…”

Three-dimensional High-speed Optical Coherence Tomography for Diagnosis of Hypotony Maculopathy After Glaucoma Filtration Surgery

“…Macular folds associated with ocular hypotony tend to be oriented along the 0–180 degree axis 11. Bullock and Egbert 18 hypothesized that anterior retinal traction induced by the optic nerve in a hypotonous globe contributed to the tendency of macular folds to have a horizontal orientation. Some eyes with macular folds appear falsely normal using TD-OCT imaging, particularly when the orientation of radial imaging is aligned horizontally along the axis of the retinal folds.…”