Focal choroidal excavation (FCE) is defined as an area of concavity in choroid detected on optical coherence tomography. These are mostly present in macular region without evidence of accompanying scleral ectasia or posterior staphyloma. Though initially considered to be congenital, increasing number of cases have been identified in association with other choroidal pathologies such as central serous choroidopathy, choroidal neovascularisation, polypoidal choroidal vasculopathy, choroiditis, choroidal tumours. In this review article, we aim to elaborate on the morphology, pathogenesis and differential diagnosis of FCE and specifically discuss the spectrum of diseases with known association along with the impact of their treatment on FCE

Purpose:To evaluate the correlation between the retinal nerve fiber layer (RNFL), particularly the temporal RNFL (TRNFL), and visual outcomes following surgery for rhegmatogenous retinal detachment (RRD).Methods:This retrospective study was performed at a tertiary center; 32 patients underwent single and successful vitrectomy for total RRD using silicone oil as tamponade. Data were collected after oil removal. RNFL thickness and central foveal thickness (CFT) were measured using spectral domain optical coherence tomography. RNFL thickness and CFT of normal eyes were acquired as a control to calculate percentage changes in the affected eyes. The correlation between postoperative best-corrected visual acuity (BCVA) and TRNFL changes was the primary outcome measure.Results:Postoperative BCVA correlated negatively with retinal detachment (RD) duration (Pearson coefficient 0.56, P = 0.001) and percentage loss in TRNFL thickness (Pearson Coefficient 0.41, P = 0.02). The macula lost the maximum RNFL thickness (26%). The mean percentage loss of TRNFL was significantly higher in patients with postoperative BCVA <6/60 (42.63% vs. 24.06%, P = 0.009). Patients with postoperative BCVA <6/60 had a significantly longer mean RD duration (29 days) than those with postoperative BCVA >6/60 (17.5 days) (P = 0.026).Conclusion:When eyes with RRD are successfully repaired using silicone oil tamponade, the thickness of the RNFL decreases, particularly in the macula, and less macular neuronal loss is associated with better visual outcomes.

Topical anesthesia without any sedation is a viable option, comparable to peribulbar block, for performing vitrectomy in selected group of patients requiring vitrectomy and thus avoiding complication of injection anesthesia and quicker postoperative recovery.

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