Focal Choroidal Excavation

Focal Choroidal Excavation

Has been described as excavation in the choroid usually seen in macular area.

It can be Congenital or Acquired

Certain disorders like  Polypoidal choroidal vasculopathy (PCV), CSCR and lacquer crack had a close topographic relationship with the FCE.

Can be secondary to viral infection – EBV

FCE can be isolated or can occur within choroidal osteoma, Bests disease, stargardts disease.

Usually seen in fourth or fifth decades, and most were moderately myopic       

           and no sexual predilection.

Clinically, very difficult to detect these lesions. The lesions may appear as either retinal pigment epithelial  disturbances or yellowish spots. The lesions were mostly hypoautofluorescent and typically showed transmission defects with retinal pigment epithelial attenuation on fluorescein angiography.

Two patterns of excavation were detected using SD-OCT.

1.     Conforming FCE - no separation between the photoreceptor tips and the retinal pigment epithelium, with the outer nuclear layer appearing thicker than it does in areas not affected by excavation.

2.     Nonconforming FCE - photoreceptor tips detached from the underlying retinal pigment epithelium, with the intervening hyporeflective space presumably representing subretinal fluid.

Eyes with conforming FCE could progress to nonconforming lesions as stress on the outer retina results in separation of the photoreceptors tips from the apical surface of the retinal pigment epithelium.

Because the normal choroid has been shown to become thinner with age,  it is possible that the choroidal excavation may enlarge with time, resulting in further ischemia to the overlying retina, atrophic changes, and visual disturbances

Close follow up is required to look for CNVM (generally Type I CNVM).

These CNVM associated with choroidal excavation may be resistant to Anti-VEGF. Eyelea – better treatment response, as it works better in case of choroidal abnormalities