The patient was a 41-year-old man who has had distorted vision in the right eye for 9 years, which he first noticed after having an ocular migraine. His visual acuity was 20/30-1 OD and 20/20 OS. The examination was remarkable for small drusenoid changes, right eye greater than left. What is this patient’s diagnosis? What treatment, if any, should be offered?
The patient had focal choroidal excavation (FCE), right eye greater than left. There were also drusen, which were likely familial and might have been unrelated to the FCE. FCE is characterized by a concavity of the choroid without associated scleral ectasia or other changes. It is usually unilateral and is often asymptomatic. Most cases are subfoveal or juxtafoveal. Many patients have myopic maculopathy or a condition along the pachychoroid spectrum such as central serous chorioretinopathy or polypoidal choroidal vasculopathy. Our patient had pachyvessels (note the unusually large choroidal blood vessels in each eye) but did not have a significantly thickened choroid in either eye. There is no specific treatment for FCE, but it can be associated with choroidal neovascular membrane formation.
References
Margolis R, Makkamala SK, Jampol LM. The expanded spectrum of focal choroidal excavation. Arch Ophthalmol. 2011;129:1320-1325.
Verma S, Kumar V, Azad S. Focal choroidal excavation: review of literature. Br J Ophthalmol. 2021;105:1043-1048.
The patient had focal choroidal excavation (FCE), right eye greater than left. There were also drusen, which were likely familial and might have been unrelated to the FCE. FCE is characterized by a concavity of the choroid without associated scleral ectasia or other changes. It is usually unilateral and is often asymptomatic. Most cases are subfoveal or juxtafoveal. Many patients have myopic maculopathy or a condition along the pachychoroid spectrum such as central serous chorioretinopathy or polypoidal choroidal vasculopathy. Our patient had pachyvessels (note the unusually large choroidal blood vessels in each eye) but did not have a significantly thickened choroid in either eye. There is no specific treatment for FCE, but it can be associated with choroidal neovascular membrane formation.
References
Margolis R, Makkamala SK, Jampol LM. The expanded spectrum of focal choroidal excavation. Arch Ophthalmol. 2011;129:1320-1325.
Verma S, Kumar V, Azad S. Focal choroidal excavation: review of literature. Br J Ophthalmol. 2021;105:1043-1048.
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