How would approach this case of focal choroidal excavation?

Thirty-year-old female complaining from metamorphopsia vision is 20/25

She reports that she previously had metamorphopsia nine years ago, and an ophthalmologist treated her with anti-VEGF.

Fundus image

Her fundus photograph shows a retinal scar with an abnormal foveal reflex.

Fundus picture of the focal choroidal excavation

Optical coherence tomography

Her OCT scan shows focal choroidal excavation forming a hyporeflective space and a disrupted ellipsoid zone, which explains the distorted vision. However, the negative cross-section shows normal retinal thickness with no elevation of retinal tissues and focal choroidal excavation with choroidal thickening and dilated vessel diameter in Haller's layer forming pachychoroid.

OCT cross-section shows focal choroidal excavation with pachychoroid

OCT cross-section (Negative) shows focal choroidal excavation with pachychoroid

Fundus fluorescein angiography

FFA shows early hyper fluorescence, which increases in later phases in the form of a hotspot.

Early phase FFA shows early hyperfluorescence from a hotspot

Mid phase FFA shows increased hyperfluorescence from a hotspot

Mid phase shows increased hyperfluorescence from a hotspot

Late phase FFA shows early hyperfluorescence from a hotspot

Diagnosis is a focal choroidal excavation.

Discussion

Focal choroidal excavation is focal cupping of the choroid and not associated with any systemic disease. It usually features symptoms such as metamorphopsia or reduced vision, which can be accompanied by central serous chorioretinopathy or CNVm or polypoidal choroidal vasculopathy, which may cause atrophy and RPE pump dysfunction.

The underlying etiology and mechanism is unknown but assumed to be congenital. Whenever the photoreceptors are detached from the RPE, it is termed non-conforming, which exhibited hypo reflective space, and the photoreceptors are not detached from the RPE. It is termed as conforming; however, it has a favorable prognosis when the associated pathology is treated.

I treated this patient as central serous chorioretinopathy by performing a microsecond subthreshold laser.

How would you manage this case??

Please check Clinical guidelines for central serous chorioretinopathy

Comments

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