Focal choroidal excavation

Focal choroidal excavation (FCE) is a concavity in the choroidal layer of the eye that can be detected by optical coherence tomography. The disease is usually unilateral and not associated with any accompanying systemic diseases.

Focal choroidal excavation
SpecialtyOphthalmology
Diagnostic methodoptical coherence tomography
TreatmentUsually observation without treatment

Pathophysiology

Focal choroidal excavation (FCE) is a concavity in the choroidal layer of the eye without posterior staphyloma or scleral ectasia, that can be detected by optical coherence tomography.[1] The concavity is commonly seen in the macular region.[2] The disease is usually unilateral and not associated with any accompanying systemic diseases.[3]

Choroidal vascular disorders which cause visual symptoms, including central serous chorioretinopathy (CSCR), choroidal neovascularization (CNV), and polypoidal choroidal vasculopathy (PCV) may also present with focal choroidal excavation.[3]

Etiology

The exact etiology of FCE is still (as of 2022) unknown.[4] It was previously considered a congenital disease, but later it was suggested that FCEs can also occur with choroidal atrophy and choroiditis.[4]

Signs and symptoms

In FCE, visual acuity may be normal and the overlying retina may also appear normal.[4][5]

Classification

There are three types of classification systems used to classify FCE.

If there is no separation between photoreceptor outer segments and the retinal pigment epithelium (RPE), it is classified as conforming and if there is a space it is considered as non-conforming.[6]

Based on shape of the choroidal concavity FCE can be classified as cone-shaped, bowl-shaped, or mixed morphology.[6] Based on the location of the lesion, it can be classified as foveal or extrafoveal.[6]

Treatment

Asymptomatic FCE without any other choroidal or retinal changes, observation is only recommended.[6] If the lesion expands or the sclera thickens, rule out other underlying causes and treat it.[6]

History

Jampol et al. first identified the lesion in 2006.[3] Margolis et al. named the condition as focal choroidal excavation.[3] Later Shinojima et al. described a classification system based on shape of the choroidal concavity.[6]

References
  1. Kuroda, Yoshimasa; Tsujikawa, Akitaka; Ooto, Sotaro; Yamashiro, Kenji; Oishi, Akio; Nakanishi, Hideo; Kumagai, Kyoko; Hata, Masayuki; Arichika, Shigeta; Ellabban, Abdallah A.; Yoshimura, Nagahisa (2014-09-01). "Association of Focal Choroidal Excavation With Age-Related Macular Degeneration". Investigative Ophthalmology & Visual Science. 55 (9): 6046–6054. doi:10.1167/iovs.14-14723. ISSN 1552-5783. PMID 25190653.
  2. Verma, Saurabh; Kumar, Vinod; Azad, Shorya; Bhayana, Amber Amar; Surve, Abhidnya; Kumar, Suneel; Agarwal, Pulak; Chawla, Rohan; Venkatesh, Pradeep (2021-08-01). "Focal choroidal excavation: review of literature". British Journal of Ophthalmology. 105 (8): 1043–1048. doi:10.1136/bjophthalmol-2020-316992. ISSN 0007-1161. PMID 32788327. S2CID 221126332.
  3. Cebeci, Zafer; Bayraktar, Şerife; Oray, Merih; Kır, Nur (December 2016). "Focal Choroidal Excavation". Turkish Journal of Ophthalmology. 46 (6): 296–298. doi:10.4274/tjo.24445. ISSN 2149-8695. PMC 5177789. PMID 28050329.
  4. Chung, C. Y.; Li, S. H.; Li, K. K. W. (September 2017). "Focal choroidal excavation—morphological features and clinical correlation". Eye. 31 (9): 1373–1379. doi:10.1038/eye.2017.71. ISSN 1476-5454. PMC 5601452. PMID 28452991.
  5. Turgut, Burak (2017-03-25). "The frequency of focal choroidal excavation detected by optical coherence tomography". International Journal of Ophthalmic Research. 3 (1): 220–225. doi:10.17554/j.issn.2409-5680.2017.03.61. ISSN 2409-5680.
  6. "Focal Choroidal Excavation (FCE) - EyeWiki". eyewiki.aao.org. Retrieved 2022-08-18.
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