Focal choroidal excavation | |
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Specialty | Ophthalmology |
Diagnostic method | optical coherence tomography |
Treatment | Usually observation without treatment |
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 (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]
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]
In FCE, visual acuity may be normal and the overlying retina may also appear normal. [4] [5]
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]
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]
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]
Hypertensive retinopathy is damage to the retina and retinal circulation due to high blood pressure.
The optic disc or optic nerve head is the point of exit for ganglion cell axons leaving the eye. Because there are no rods or cones overlying the optic disc, it corresponds to a small blind spot in each eye.
Sattler's layer, named after Hubert Sattler, an Austrian ophthalmologist, is one of five layers of medium-diameter blood vessels of the choroid, and a layer of the eye. It is situated between the Bruch's membrane, choriocapillaris below, and the Haller's layer and suprachoroidea above, respectively. The origin seems to be related to a continuous differentiation throughout the growth of the tissue and even further differentiation during adulthood.
Optic disc drusen (ODD) are globules of mucoproteins and mucopolysaccharides that progressively calcify in the optic disc. They are thought to be the remnants of the axonal transport system of degenerated retinal ganglion cells. ODD have also been referred to as congenitally elevated or anomalous discs, pseudopapilledema, pseudoneuritis, buried disc drusen, and disc hyaline bodies.
Optic pit, optic nerve pit, or optic disc pit (ODP) is rare a congenital excavation of the optic disc, resulting from a malformation during development of the eye. The incidence of ODP is 1 in 10,000 people with no predilection for either gender. There is currently no known risk factors for their development. Optic pits are important because they are associated with posterior vitreous detachments (PVD) and even serous retinal detachments.
Macular hypoplasia is a rare medical condition involving the underdevelopment of the macula, a small area on the retina responsible for seeing in detail and sensing light. Macular hypoplasia is often associated with albinism.
Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is an acquired inflammatory uveitis that belongs to the heterogenous group of white dot syndromes in which light-coloured (yellowish-white) lesions begin to form in the macular area of the retina. Early in the course of the disease, the lesions cause acute and marked vision loss that ranges from mild to severe but is usually transient in nature. APMPPE is classified as an inflammatory disorder that is usually bilateral and acute in onset but self-limiting. The lesions leave behind some pigmentation, but visual acuity eventually improves even without any treatment.
Fundus photography involves photographing the rear of an eye, also known as the fundus. Specialized fundus cameras consisting of an intricate microscope attached to a flash enabled camera are used in fundus photography. The main structures that can be visualized on a fundus photo are the central and peripheral retina, optic disc and macula. Fundus photography can be performed with colored filters, or with specialized dyes including fluorescein and indocyanine green.
Choroidal neovascularization (CNV) is the creation of new blood vessels in the choroid layer of the eye. Choroidal neovascularization is a common cause of neovascular degenerative maculopathy commonly exacerbated by extreme myopia, malignant myopic degeneration, or age-related developments.
Intraocular hemorrhage is bleeding (hemorrhage) inside the eye. Bleeding can occur from any structures of the eye where there is a presence of vasculature or blood flow. It can bleed inside the anterior chamber, vitreous cavity, retina, choroid, suprachoroidal space, or Optic disc. Intraocular hemorrhage can be subdivided depending on the location of the bleed. It may be the result of physical trauma, an uncommon side effect due to post op ocular surgery or other diseases, injuries or disorders. Severe bleeding may cause high pressures inside the eye, leading to blindness.
Macular telangiectasia is a condition of the retina, the light-sensing tissue at the back of the eye that causes gradual deterioration of central vision, interfering with tasks such as reading and driving.
Berlin's edema a common condition caused by blunt injury to the eye. It is characterized by decreased vision in the injured eye a few hours after the injury. Under examination the retina appears opaque and white in colour in the periphery but the blood vessels are normally seen along with "cherry red spot" in the foveal region. This whitening is indicative of cell damage, which occurs in the retinal pigment epithelium and outer segment layer of photoreceptors. Damage to the outer segment often results in photoreceptor death through uncertain mechanisms. Usually there is no leakage of fluid and therefore it is not considered a true edema. The choroidal fluorescence in fluorescent angiography is absent. Visual acuity ranges from 20/20 to 20/400.
Vitreomacular adhesion (VMA) is a human medical condition where the vitreous gel of the human eye adheres to the retina in an abnormally strong manner. As the eye ages, it is common for the vitreous to separate from the retina. But if this separation is not complete, i.e. there is still an adhesion, this can create pulling forces on the retina that may result in subsequent loss or distortion of vision. The adhesion in of itself is not dangerous, but the resulting pathological vitreomacular traction (VMT) can cause severe ocular damage.
Geographic atrophy (GA), also known as atrophic age-related macular degeneration (AMD) or advanced dry AMD, is an advanced form of age-related macular degeneration that can result in the progressive and irreversible loss of retinal tissue which can lead to a loss of visual function over time. It is estimated that GA affects >5 million people worldwide and approximately 1 million patients in the US, which is similar to the prevalence of neovascular (wet) AMD, the other advanced form of the disease.
Optical coherence tomography angiography (OCTA) is a non-invasive imaging technique based on optical coherence tomography (OCT) developed to visualize vascular networks in the human retina, choroid, skin and various animal models. OCTA may make use of speckle variance optical coherence tomography.
Pachychoroid disorders of the macula represent a group of diseases affecting the central part of the retina of the eye, the macula. Due to thickening and congestion of the highly vascularized layer underneath the macula, the choroid, damage to the retinal pigment epithelium and the retinal photoreceptor cells ensues. This leads to impaired vision. The best known representative of the pachychoroid disease spectrum, central serous chorioretinopathy, is the fourth most common cause of irreversible damage to the macula:.
Speckle variance optical coherence tomography (SV-OCT) is an imaging algorithm for functional optical imaging. Optical coherence tomography is an imaging modality that uses low-coherence interferometry to obtain high resolution, depth-resolved volumetric images. OCT can be used to capture functional images of blood flow, a technique known as optical coherence tomography angiography (OCT-A). SV-OCT is one method for OCT-A that uses the variance of consecutively acquired images to detect flow at the micron scale. SV-OCT can be used to measure the microvasculature of tissue. In particular, it is useful in ophthalmology for visualizing blood flow in retinal and choroidal regions of the eye, which can provide information on the pathophysiology of diseases.
Sickle cell retinopathy can be defined as retinal changes due to blood vessel damage in the eye of a person with a background of sickle cell disease. It can likely progress to loss of vision in late stages due to vitreous hemorrhage or retinal detachment. Sickle cell disease is a structural red blood cell disorder leading to consequences in multiple systems. It is characterized by chronic red blood cell destruction, vascular injury, and tissue ischemia causing damage to the brain, eyes, heart, lungs, kidneys, spleen, and musculoskeletal system.
Choroidal nevus is a type of eye neoplasm that is classified under choroidal tumors as a type of benign (non-cancerous) melanocytic tumor. A choroidal nevus can be described as an unambiguous pigmented blue or green-gray choroidal lesion, found at the front of the eye, around the iris, or the rear end of the eye.
Polypoidal choroidal vasculopathy (PCV) is an eye disease primarily affecting the choroid. It may cause sudden blurring of vision or a scotoma in the central field of vision. Since Indocyanine green angiography gives better imaging of choroidal structures, it is more preferred in diagnosing PCV. Treatment options of PCV include careful observation, photodynamic therapy, thermal laser, intravitreal injection of anti-VEGF therapy, or combination therapy.