Original article
Choroidal Neovascularization Associated With Focal Choroidal Excavation

https://doi.org/10.1016/j.ajo.2013.12.011Get rights and content

Purpose

To describe the clinical and imaging characteristics of choroidal neovascularization (CNV) accompanied by focal choroidal excavation.

Design

Retrospective, interventional case series.

Methods

The medical records of 16 patients (16 eyes) were reviewed. Imaging findings including fluorescein angiography (FA), indocyanine green angiography, and spectral-domain optical coherence tomography (SD OCT) were analyzed.

Results

CNV complexes were primarily located beneath the retinal pigment epithelium (type 1 CNV) in 9 eyes and in the subneurosensory retinal space (type 2 CNV) in 7 eyes, as assessed by SD OCT. Seven of 8 patients over 50 years old had type 1 CNV, and 6 of 8 patients under 50 had type 2 lesions. All 7 eyes with type 2 CNV exhibited classic CNV on FA. Additionally, 7 of 9 eyes with type 1 CNV had the classic pattern, and in these eyes, the CNV complexes were confined to the concavity of choroidal excavation. In 15 patients treated by anti–vascular endothelial growth factor (anti-VEGF) injections, the mean best-corrected visual acuity improved from 20/44 to 20/26 with a mean of 3.7 injections during a mean follow-up period of 14.5 months.

Conclusions

The CNV growth pattern and extent seem to be determined by the degree of damage to the retinal pigment epithelium/Bruch membrane complex resulting from choroidal excavation, as well as age. Neovascular complexes tend to be located within the boundary of choroidal excavation and are revealed as classic patterns on FA, even in type 1 CNV. Anti-VEGF was notably effective for treating these lesions, with a low rate of recurrence.

Section snippets

Methods

We analyzed the medical records and imaging studies of 689 eyes from 653 consecutive patients with CNV or polypoidal choroidal vasculopathy who were referred to the ophthalmology department of Seoul St. Mary's Hospital, The Catholic University of Korea, between the beginning of January 2009 and the end of March 2013. Sixteen patients were diagnosed as having CNV accompanied by focal choroidal excavation. Detailed clinical and imaging characteristics were evaluated in these patients. This

Results

The patient characteristics are summarized in the Table. We studied 16 eyes in 16 Korean patients, 9 of whom were women. The mean age was 49.6 years (range, 28-86 years). Eight patients were under 50 years old; 2 among them had a history of CSC in the affected eyes and 1 patient had high myopia. Soft drusen was only noted in 1 of 8 patients over 50. None of the patients had a history of medical illness, medication use, or a family history of retinal disease. None of the cases were bilaterally

Discussion

In our series, all 16 choroidal neovascular complexes involved the area of choroidal excavation on OCT, with 12 being located within the boundary of excavation and 4 extending over the margin. This close topographic relationship supports the notion that choroidal excavation plays a role in the development of CNV. Choroidal thinning at the area of excavation was observed in nearly all patients, which is consistent with the results of other studies.4, 5 By ICGA, focal hypofluorescence

Jae Hyung Lee, MD, graduated from Catholic University of Korea, College of Medicine in 2008 where he completed internship and residency in 2013. He is currently pursuing his first year of retinal fellowship in Seoul St. Mary's Hospital. His research interests include age-related macular degeneration and polypoidal choroidal vasculopathy.

References (20)

There are more references available in the full text version of this article.

Cited by (0)

Jae Hyung Lee, MD, graduated from Catholic University of Korea, College of Medicine in 2008 where he completed internship and residency in 2013. He is currently pursuing his first year of retinal fellowship in Seoul St. Mary's Hospital. His research interests include age-related macular degeneration and polypoidal choroidal vasculopathy.

View full text
Copyright © 2014 Elsevier Inc. All rights reserved.