PMC3448114_01
Findings in a 58-year-old man with bilateral focal choroidal excavation. a, c, e Images of the right eye. b, d, f Images of the left eye. a, b Fundus photographs on the initial presentation show RPE alterations beneath and adjacent to the fovea. c, d FAF image shows a focal area of hypoautofluorescence. e, f SD-OCT image with enhanced depth imaging through the fovea shows two concave-shaped conforming focal choroidal excavation (arrows) in both eyes. The excavations involved the outer retinal layers up to the ELM. The ELM band and the photoreceptor inner segment/outer segment junction can be seen at the excavation.
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F1
Fundus examination showed mottling of the RPE beneath and adjacent to the fovea (fig. 1a, b). Enhanced depth imaging OCT (EDI-OCT) demonstrated 2 focal choroidal excavations in the macula of both eyes in spite of a normal fovea contour (fig. 1e, f). The area of the excavation in the fundus autofluorescent (FAF) images was hypofluorescent (fig. 1c, d).
Case 1. a, c Images of the right eye. b, d Images of the left eye. a, b Microperimetry using MP-1 (Nidek, Japan) shows a decrease of retinal sensitivity in the foveal region in both eyes. c, d Results of mfERG using an LE-4100 (Tomey, Japan). Three-dimensional topographic map of the mfERG responses showing a decrease in the P1 response amplitude in the foveal region of the left eye.
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F2
Microperimetry with the MP-1 (Nidek, Gamagori, Japan) showed a decrease in retinal sensitivity in the foveal region of both eyes (fig. 2a, b). The P1 amplitudes of the multifocal electroretinograms (mfERGs) were decreased in the foveal region of the left eye (fig. 2d).
PMC3448114_02
Findings in a 34-year-old woman with a focal choroidal excavation accompanied with type 2 CNV in the left eye. a Color photograph shows RPE alterations superior to the fovea. b FAF image shows an irregular area of hypofluorescence. c Fluorescein angiography in the late phase shows a classic CNV in the fovea. d Indocyanine green angiography in the late phase shows a classic CNV in the fovea. e SD-OCT at the initial examination shows a focal choroidal excavation with a type 2 CNV. The ELM band and the photoreceptor inner segment/outer segment junction are indistinct at the excavation. f SD-OCT scan taken 1 month after the initial presentation shows a type 2 CNV with subretinal fluid. g SD-OCT scan taken 5 months later shows a regression of the type 2 CNV after treatment with intravitreal bevacizumab injection.
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F3
Fundus examination showed RPE mottling superior to the fovea (fig. 3a). SD-OCT demonstrated a concave-shaped choroidal excavation associated with type 2 choroidal neovascularization (CNV) in the macula of the left eye (fig. 3e). FAF showed that the lesion was irregularly hypoautofluorescent (fig. 3b). The fluorescein angiography images showed a type 2 CNV in the fovea with irregular hyperfluorescence superior to the fovea corresponding to the RPE mottling (fig. 3c). One month after the initial examination, her BCVA decreased to 0.4 OS accompanied by the presence of subretinal fluid and hemorrhage (fig. 3f). After three monthly intravitreal bevacizumab injections, the BCVA improved to 1.5, and SD-OCT scan showed a regression of the type 2 CNV (fig. 3g).