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User Question/Comment:
This case was submitted by Dr Mona Sandhu. It is lightly edited for clarity and formatting.
This is a 45 year old Asian female with spectacle correction of -4.75 and -4.00 with 20/20 BCVA OD/OS. Her OCT showed choroidal excavation in OD only. What kind of follow-up is required and what is the etiology?
Dr Lederer’ Response:
Mona is a regular EyeCarePD contributor and the depth and breadth of her practice always amazes me!
I completely agree that this is a case of focal choroidal excavation (FCE). You question is so important so let me offer a few comments working backwards.
Around 2006 was the first time we began to more formally recognize these cases. It took another few years for the literature to begin to accumulate and OCT technology to improve allowing us to further understand this finding. But even now we do not know the precise etiology. Most specialists believe this to be a congenital posterior segment malformation. This is because acquired lesions from inflammatory disease would be expected to leave behind altered retinal anatomy. And this is not the case in FCE. Specifically, the retinal layers are usually intact with normal ellipsoid bands (as in your case). In some cases there can be a hypolucency below the retina helping to divide the condition between conforming and nonconforming FCE types. It is worth noting that there is no evidence of scleral abnormalities and thus FCE is not a true staphyloma.
We do know that FCE is more commonly seen in myopic patients with a relatively thicker choroid then one might expect. Central serous retinopathy can be a concomitant finding but choroidal neovascularization is rare. In terms of follow-up I recommend seeing these patients once per year and, at a minimum, performing OCT testing. As with many maculopathies it is a good idea to explain the importance of home monitoring and the need to rapidly return for repeat evaluation should symptoms arise.
Thank you again Mona for the great case and keep up the great work.