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This study aimed to evaluate visual function and perform multimodal imaging on patients with focal choroidal excavation without any chorioretinal disease (idiopathic focal choroidal excavation [iFCE]). Seventeen eyes of 15 patients with iFCE (8 men, 7 women; mean ± standard deviation age, 56.0 ± 10.8 years) were assessed for visual function including visual acuity, metamorphopsia, aniseikonia, and retinal sensitivity. Multimodal imaging included optical coherence tomography (OCT), fundus autofluorescence (FAF), and OCT angiography. This study found that the maximum width and depth of the excavation were 597 ± 330 (238-1809) µm and 123 ± 45 (66-231) µm, respectively, and that FAF showed normal or hypoautofluorescence corresponding to iFCE. The fundus examination findings were stable during the follow-up period (96 ± 48 months). None of the eyes showed any abnormalities in central retinal sensitivity or aniseikonia. Metamorphopsia was detected using Amsler grid testing and M-CHARTS in two eyes. Therefore, this study is the first to quantitatively and qualitatively study metamorphopsia of patients with iFCE. Our results showed that most patients with iFCE did not have visual impairments, despite the presence of morphological changes in the outer retina and choroid.
Assuntos
Doenças da Coroide , Imagem Multimodal , Tomografia de Coerência Óptica , Acuidade Visual , Humanos , Pessoa de Meia-Idade , Feminino , Masculino , Imagem Multimodal/métodos , Tomografia de Coerência Óptica/métodos , Idoso , Adulto , Doenças da Coroide/diagnóstico por imagem , Doenças da Coroide/patologia , Corioide/diagnóstico por imagem , Corioide/patologia , Angiofluoresceinografia/métodos , Retina/diagnóstico por imagem , Retina/patologia , Transtornos da Visão/diagnóstico por imagemRESUMO
PURPOSE: This study aims to present long-term observation of 5 eyes with focal choroidal excavation (FCE), focusing on morphological changes in conformity of the lesion. METHODS: A retrospective case series was conducted, including 5 eyes of 5 patients with FCE. The study utilized multimodal imaging including color fundus photography, optical coherence tomography (OCT), enhanced depth imaging OCT (EDI-OCT), fundus fluorescein angiography (FFA), fundus autofluorescence (FAF), red free imaging, and OCT angiography. RESULTS: The mean age at diagnosis was 51 ± 10.65 years, with a mean follow-up period 37 ± 13.59 months. All cases were unilateral, with 1 presenting FCE as an isolated lesion, and one patient exhibiting 2 FCEs in one eye. The mean choroidal thickness measured by EDI-OCT was 268.2 ± 63.39 µm in the affected eye. One patient displayed choroidal thickening and pachyvessels. Of the 5 eyes, one had conforming and 4 non-conforming FCE. We observed a conversion in conformity in all patients, with 4 cases transitioning from non-conforming FCE to conforming type (3 spontaneously, 1 treatment-induced). In conforming FCE, a hyporeflective space appeared twice between neuroretina and retinal pigment epithelium with spontaneous regression. CONCLUSION: We observed change in shape from the conforming to non-conforming FCE and vice versa in all patients. We consider this small change in the hyporeflective space as non-pathologic and clinically insignificant.
Assuntos
Coriorretinopatia Serosa Central , Doenças da Coroide , Humanos , Adulto , Pessoa de Meia-Idade , Doenças da Coroide/diagnóstico por imagem , Doenças da Coroide/patologia , Seguimentos , Estudos Retrospectivos , Coriorretinopatia Serosa Central/patologia , Corioide/patologia , Tomografia de Coerência Óptica/métodos , Angiofluoresceinografia/métodosRESUMO
INTRODUCTION: Alagille syndrome (AGS) is a genetic disease with multisystemic affection, including ocular manifestations. Recently, a high frequency of posterior segment findings, including macular changes, has been reported. This publication aims to report an unusual finding of macular atrophy and a focal choroidal excavation in a patient with JAG1 related AGS. METHODS: Case report. RESULTS: This publication describes an atypical presentation of focal choroidal excavation (FCE) and unilateral macular atrophy in a 7-year-old male with Alagille syndrome (AGS). Genetic analysis revealed a pathogenic variant in the JAG1 gene. Ophthalmological examination and imaging findings demonstrated characteristic ocular manifestations of AGS, including posterior embryotoxon, chorioretinal atrophy, and thinning of the choroid. CONCLUSION: The presence of FCE in AGS is uncommon, and the underlying mechanisms remain unclear. Further exploration of similar cases is necessary to better understand the evolution and visual prognosis in patients with AGS and FCE.
This case report highlights the presence of focal choroidal excavation and unilateral macular atrophy in a patient with Alagille syndrome. The genetic analysis identified a pathogenic variant in the JAG1 gene.
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Síndrome de Alagille , Proteína Jagged-1 , Humanos , Síndrome de Alagille/genética , Síndrome de Alagille/complicações , Síndrome de Alagille/diagnóstico , Síndrome de Alagille/patologia , Proteína Jagged-1/genética , Masculino , Criança , Tomografia de Coerência Óptica , Doenças da Coroide/genética , Doenças da Coroide/diagnóstico , Angiofluoresceinografia , Acuidade Visual/fisiologia , Atrofia , Macula Lutea/patologia , Macula Lutea/anormalidades , Corioide/patologia , Corioide/anormalidadesRESUMO
BACKGROUND: Multiple evanescent white dot syndrome (MEWDS)-like features is a rare condition triggered by a macular disease or iatrogenic injury, exhibiting MEWDS changes in the fundus. This study aims to describe the multimodal imaging features and outcomes of multifocal choroiditis/punctate inner choroidopathy (MFC/PIC) lesions with MEWDS-like features. METHODS: Six cases were studied retrospectively. All cases were given regional and oral corticosteroids. RESULTS: All cases showed an isolated juxtafoveal yellowish-white MFC/PIC lesion with disruption of RPE-Bruch's membrane-choriocapillaris complex (RPE-BM-CC), subretinal hyperreflective materials and choroidal thickening on optical coherence tomography. Two weeks after presentation, the grayish-white dots disappeared spontaneously and the corticosteroids were given. After four weeks, the ellipsoid zone (EZ) around the lesion and hyper-autofluorescence resolved. After 13 weeks, five cases showed shrinkage of the juxtafoveal lesion and restoration of foveal EZ. After six months, the juxtafoveal lesion became pigmented. Only one case developed type 2 choroidal neovascularization. CONCLUSIONS: The clinical course of MEWDS-like manifestations is still evanescent in our cases. The yellowish-white juxtafoveal MFC/PIC lesions with disruption of RPE-BM-CC and choroidal thickening showed a well-controlled prognosis after corticosteroid treatment.
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Corioidite , Síndrome dos Pontos Brancos , Humanos , Coroidite Multifocal , Estudos Retrospectivos , Corioidite/diagnóstico , Corioidite/tratamento farmacológico , Síndrome dos Pontos Brancos/diagnóstico , Corticosteroides/uso terapêutico , Imagem Multimodal/métodos , Angiofluoresceinografia/métodos , Tomografia de Coerência Óptica/métodosRESUMO
Purpose We report a case of focal choroidal excavation (FCE) that resolved after intravitreal injection of anti-vascular endothelial growth factor (VEGF) for choroidal neovascularization (CNV) and we describe its tomographic features. Case report A 43-year-old female presented with blurred vision and metamorphopsia in her left eye (LE) evolving for 10 years. The best corrected visual acuity (BCVA) was 20/20 in the right eye and 20/32 in the LE. Fundus examination revealed the presence of a yellowish foveal lesion which corresponded to a conforming FCE associated to a pachychoroid on swept-source optical coherence tomography (OCT). The OCT-Angiography showed a foveal flow void in the choriocapillaris layer corresponding to the FCE area. Three years later, the patient complained of visual impairment, more metamorphopsia with a BCVA of 20/80 on her LE. The OCT showed intraretinal fluid with a foveal retinal pigment epithelium (RPE) detachment. The OCT-angiography confirmed the presence of CNV. Two months after one intravitreal bevacizumab injection, the OCT documented the complete resolution of macular edema, the regression of the CNV tissue and the restoration of a normal aspect of the fovea without any FCE. Her BCVA improved to 20/32 with resolution of the metamorphopsia. The OCT aspect remained stable during 3 years of follow-up. Conclusion CNV can develop in FCE and anti-VEGF therapy is a good option treatment. After treatment, FCE pattern can change et may completely resolve.
Assuntos
Neovascularização de Coroide , Edema Macular , Humanos , Feminino , Adulto , Neovascularização de Coroide/diagnóstico por imagem , Neovascularização de Coroide/tratamento farmacológico , Corioide/diagnóstico por imagem , Corioide/patologia , Tomografia de Coerência Óptica/efeitos adversos , Tomografia de Coerência Óptica/métodos , Transtornos da Visão/complicações , Transtornos da Visão/patologiaRESUMO
ABSTRACT A 39-year-old policeman complained of decreased bilateral central vision over the last two years. On examination, visual acuity was 20/40 and 20/400 in the right (OD) and left eye (OS), respectively, and fundoscopy revealed a bilateral hypopigmented macular lesion. Fluorescein and indocyanine green angiography demonstrated leakage and hyperintense spots, respectively, within the macular areas. At baseline, optical coherence tomography showed subretinal fluid in the OD and a conforming focal choroidal excavation in the OS. Focal choroidal excavation converted from conforming to nonconforming type at 4-month follow-up and then reversed to conforming type at 12-month follow-up, and was associated with incomplete retinal pigment epithelium and outer retina atrophy over the area of excavation. Pachyvessels were also evidenced in the choroid, without neovascularization. We report for the first time a case of focal choroidal excavation that progressed from conforming to nonconforming type and then reverted to its primary configuration (conforming type) in a patient with concurrent bilateral central serous chorioretinopathy.
RESUMO Um policial de 39 anos se queixava de diminuição bilateral da visão central nos últimos 2 anos. A acuidade visual era 20/40 e 20/400 no olho direito (OD) e esquerdo (OE) e a fundoscopia revelou lesão macular hipopigmentada bilateral. A angiografia fluoresceínica e com indocianina verde revelaram, respectivamente, vazamento do corante e áreas hiperintensas nas regiões maculares. A tomografia de coerência óptica evi denciou fluido sub-retiniano no OD e escavação focal de coroide do tipo conformacional no OE. Após 4 meses, a escavação focal de coroide mudou de conformacional para não conformacional e, aos 12 meses, reverteu para conformacional associado a atrofia incompleta do epitélio pigmentar da retina e da retina externa na região da escavação. Também foi evidenciado paquicoroide, sem neovascularização. Relatamos pela primeira vez uma escavação focal de coroide que evoluiu de conformacional para não conformacional e, em seguida, retornou à configuração primária (conformacional) em um paciente com coriorretinopatia serosa central bilateral.
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PURPOSE: To evaluate the clinical presentations of focal choroidal excavation and to report long-term outcomes of cases without retinal disorders at the initial presentation. METHODS: A retrospective review of medical records was performed for patients diagnosed with focal choroidal excavation. Concomitant retinal disorders at the initial presentation were identified. In cases without retinal disorders, the development of retinal disorders during follow-up was also evaluated. RESULTS: Forty-five eyes in 45 patients were examined in this study. Focal choroidal excavation was accompanied with retinal disorders in 16 eyes (35.6%). In the remaining 29 eyes, only focal choroidal excavation was noted without any accompanying retinal disorders. The accompanying retinal disorders included choroidal neovascularization (n = 8), central serous chorioretinopathy (n = 4), epiretinal membrane (n = 1), macular hole (n = 1), branch retinal vein occlusion (n = 1), and uveitis (n = 1). Of the 29 eyes without retinal disorders, 22 were followed up for a mean period of 33.5 ± 18.2 months. Consequently, choroidal neovascularization was found to have developed in one eye at 59 months, and subretinal fluid had developed in two eyes at 17 and 28 months, respectively. CONCLUSIONS: Focal choroidal excavation was accompanied by retinal disorders in 35.6% of the included patients. In patients without retinal disorders, the development of a retinal disorder was noted in some eyes, suggesting the need for long-term regular follow-up in patients diagnosed with focal choroidal excavation.
Assuntos
Humanos , Coriorretinopatia Serosa Central , Corioide , Neovascularização de Coroide , Membrana Epirretiniana , Seguimentos , Prontuários Médicos , Perfurações Retinianas , Oclusão da Veia Retiniana , Retinaldeído , Estudos Retrospectivos , Líquido Sub-Retiniano , UveíteRESUMO
@#AIM: To observe the clinical features and optical coherence tomography(OCT)characteristics of focal choroidal excavation(FCE).<p>METHODS: The medical records of patients with FCE determined by OCT during the period of time from January 2014 to January 2016 were reviewed and analyzed. All patients underwent systematic ophthalmic examinations, including visual acuity, refractive status, slit lamp, ophthalmoscopy, OCT, etc. <p>RESULTS: Totally 24 men(26 eyes)and 15 women(16 eyes)were included in this study(20 left eyes, 16 right eyes, and 3 cases of bilateral eyes). The average age of patients was 50.4±16.7 years old. The range of patients refraction was(-2.51±2.60)D, and best corrected visual acuity(BCVA)was 0.60±0.26. Forty-six lesions were observed in 39 patients(42 eyes), with 37 cases(80%)of the conforming type and 9 cases(20%)of the nonconforming type. The average lesion width was 648.4±249.2μm and average depth was 128.0±50.4μm. BCVA in patients with the lesion under the fovea(16, 35%)was significantly lower than that with the lesion outside the fovea(<i>P</i><0.05). FCE was complicated with choroidal neovascularization(CNV)in 3 cases, macular epiretinal membranes(ERM)in one case, macular hole and(epiretinal membrane)ERM in one case, macular lamellar hole and ERM in one case. There was no significant correlation among patient's age, visual acuity, FCE width and FCE depth in linear correlation analysis(<i>P</i>>0.05). <p>CONCLUSION: FCE were mainly found in aging patients with mild and moderate myopia, mostly belonged to the conforming type in single eye. FCE was observed to complicate with macular hole, macular ERM and CNV. The visual acuity may be affected with FCE under the fovea. Further study on its etiology of FCE is needed.
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PURPOSE: To report a case of focal choroidal excavation associated with central serous chorioretinopathy. CASE SUMMARY: A 48-year-old female presented with a 20-year history of visual disturbance. Focal choroidal excavation with neurosensory retinal detachment was detected in the right eye on optical coherence tomography. Fluorescein angiography showed hyperfluorescene in the area of excavation and multiple focal hyperfluorescences in the perimacular area. Vertically linear hyperfluorescene line was detected in the excavated area caused by retinal pigment epithelial atrophy. Based on the 2 diagnostic findings, we diagnosed a focal choroidal excavation with central serous chorioretinopathy. No progression was detected for 2 months.