Conversion of Focal Choroidal Excavation With the Onset of Central Serous Chorioretinopathy: Report of 2 Cases and Review of the Literature

Abstract

Purpose: To describe two cases of focal choroidal excavation (FCE) conversion in patients with central serous chorioretinopathy.Methods: Case report and literature review of cases of FCE conversion.Results: A 35-year-old asymptomatic pregnant patient was found to have conforming FCE on spectral domain optical coherence tomography of the right eye during hydroxychloroquine screening. Three months later, she presented with decreased vision in the right eye and subretinal fluid in both eyes secondary to central serous chorioretinopathy. Spectral domain optical coherence tomography revealed that her FCE had changed to nonconforming type. A 40-year-old male patient was found to have nonconforming FCE and subretinal fluid in his right eye on spectral domain optical coherence tomography. On follow-up, spectral domain optical coherence tomography demonstrated resolution of subretinal fluid and conversion of nonconforming FCE to conforming type. Literature review showed that most cases of FCE remain stable over time. Conversion from nonconforming FCE to conforming type has been described after photodynamic therapy or anti-vascular endothelial growth factor therapy. Conversion from conforming to nonconforming type has been described in 2 cases that developed subretinal fluid in the setting of acute central serous chorioretinopathy.Conclusion: Our cases and literature review suggest that nonconforming FCE is the result of persistent subretinal fluid. Further studies are necessary to determine whether symptomatic nonconforming SRF needs treatment to reduce subretinal fluid.

Focal Choroidal Excavation and Central Serous Chorioretinopathy Following Choroidal Neovascularization: A Longitudinal Case Study

“…Although FCEs are generally asymptomatic and an evolution from conforming to nonconforming types was thought to occur with a decline in retinal elasticity over time, 2 it has been suggested that patients with nonconforming FCEs are more likely to experience metamorphopsia and are at greater risk of conversion from conforming to nonconforming types following an acute episode of CSCR. 15,16 While the sclera typically remains undisturbed, 2 we postulate that progressive choroidal ischemia and scarring with recurrent SRF and residual debris increased the hydrophobicity of the Bruch's membrane-RPE complex, making it more prone to accumulation of SRF and thus setting up a vicious cycle of recurrent CSCR and a possibly enlarging FCE.…”

The Contemporary Role of Photodynamic Therapy in the Treatment of Pachychoroid Diseases

“…Isolated conforming FCE is usually asymptomatic, and treatment is not necessary. However, conversion of conforming to nonconforming FCE with SRF accumulation due to development of CSC could occur [ 75 ]. On the other hand, conversion from nonconforming to conforming FCE due to resolution of SRF had also been observed [ 75 ].…”

“…However, conversion of conforming to nonconforming FCE with SRF accumulation due to development of CSC could occur [ 75 ]. On the other hand, conversion from nonconforming to conforming FCE due to resolution of SRF had also been observed [ 75 ]. In a retrospective case series [ 76 ] of 116 patients with CSC, 6% were noted to have coexisting FCE (around half were conforming and half were nonconforming) [ 76 ].…”