Case #71: Focal Choroidal Excavation: A Rare Sequela of Myopia? – Page 22 of 22
Acknowledgment: Thank you to Dr. Jerry Sherman for providing the case study and many useful clinical images.
Acknowledgment: Thank you to Dr. Jerry Sherman for providing the case study and many useful clinical images.
Author Zachary M. Turple, OD, MSc Zach Turple is a 2024 graduate of the New England College of Optometry where he obtained his Doctor of Optometry and Master of Science in Vision Science degrees. He is currently completing an Ocular Disease residency at the SUNY College of Optometry with an emphasis
Further Resources: Review of FCE: Verma et al. (2020)3 https://doi.org/10.1136/bjophthalmol-2020-316992 References:Jampol, L. M., Shankle, J., Schroeder, R., Tornambe, P., Spaide, R. F., & Hee, M. R. (2006). Diagnostic and therapeutic challenges. Retina, 26(9), 1072-1076.Margolis, R., Mukkamala, S. K., Jampol, L. M., Spaide, R. F., Ober, M. D., Sorenson, J. A., Gentile, R.C., Miller, J.A.,
Treatment and Management: In cases without secondary complication such as serous retinal detachment or CNVM formation, no treatment is indicated for FCE3. Patients should nonetheless be monitored annually for such potential complications. Patients should be counselled appropriately and reassured that the majority of cases are non-progressive and not visually
Differential Diagnosis: Posterior staphyloma, coloboma, torpedo maculopathy, chorioretinal atrophy and choroidal rupture are all potential differentials for FCE3.
Multimodal Imaging Features: Optical Coherence Tomography: OCT is the most valuable imaging modality for visualizing and diagnosing FCE. As previously illustrated in this case, FCE appears as an isolated depression or excavation in the inner choroid with smooth contour and borders and without underlying disruption to the scleral contour or
Conforming vs Non-conforming: Conforming-type FCE (note the PIL apposing the underlying RPE at the base of the excavation): Non-conforming type FCE (note the hyporeflective space between the neurosensory retina and choroid filling the excavation with overlying fragmentation of the PIL and RPE):
Classification – Conforming vs Non-conforming: Previous authors2 have suggested sub-classifications of FCE, including those that exhibit conforming overlying neurosensory retinal layers and those that exhibit subretinal fluid and/or debris between the RPE/Bruchs and inner choroid within the choroidal excavation.It is not currently known whether each different subtype portends a different visual
Review of the Normal OCT: ELM: External Limiting MembraneEZ/PIL: Ellipsoid Zone/Photoreceptor Integrity LineIZ: Interdigitation ZoneRPE: Retinal Pigment Epithelium
Etiology: The underlying etiology and pathophysiology of FCE remains elusive. Some authors subscribe to a congenital/developmental hypothesis2 given its apparent predilection for moderate to highly myopic eyes. Other evidence suggests FCE is an acquired condition secondary to retinal or choroidal insult (see below). Overall, it appears to be most closely