Peripapillary Intrachoroidal Cavitation in Myopia Evaluated with Multimodal Imaging Comprising “En-Face” Technique

Abstract

Objectives. To demonstrate the usefulness of “en-face” Spectral Domain Optical Coherence Tomography (SD-OCT) combined with Fluorescein Angiography (FA) in the investigation of peripapillary intrachoroidal cavitation. Materials and Methods. A 72-year-old man followed for primary open-angle glaucoma (POAG) for 4 years was referred for an asymptomatic “peripapillary lesion.” A full ophthalmological examination and conventional imaging of the retina were done. FA, Indocyanine Green Angiography (ICG-A), and SD-OCT using the “en-face” technique were also performed. Results. Best-corrected visual acuity (BCVA) was 20/25 both eyes. Slit-lamp examination revealed no abnormalities of anterior segment. Intraocular pressure (IOP) was normal. Fundus examination showed a triangular yellow-orange thickening at the inferior border of both optic nerves. FA showed early hypofluorescence of the lesion and progressive staining without any dye pooling. SD-OCT with “en-face” technique showed an intrachoroidal hyporeflective space resembling a cavitation below the retinal pigment epithelium (RPE). Conclusions. “En-face” SD-OCT and FA are valuable techniques for the diagnosis of peripapillary intrachoroidal cavitation associated with myopia. Pathophysiological insights regarding SD-OCT findings and angiography behavior are offered.

A Peripapillary Defect in a Woman With Myopia

“…Multimodal imaging including en face OCT or OCT angiography may also have a role in diagnosis. 5 Peripapillary intrachoroidal cavitation appears to be most common in pathologically myopic eyes, with mean spherical-equivalent refractions ranging from −10.99 to −11.4 1,3,6 and has been reported with moderate myopia 3 and in normal eyes. 7 Conflicting reports have found long-term complications of PICC.…”

“…More recently, Spaide et al supported the assessment by Wei et al with swept source and enhanced depth OCT imaging showing that myopic elongation produced a defect near the thin myopic conus, which allows communication between the vitreous cavity and the peripapillary sub-RPE space. Multimodal imaging including en face OCT or OCT angiography may also have a role in diagnosis …”

Peripapillary Intrachoroidal Cavitation

“…The sequence of fluorescein angiography shows early hypofluorescence followed by late hyperfluorescence without dye pooling in the area of PICC [1,2,17,22,23,28,29]. This angiographic sequence may be explained by structural choroidal changes.…”

Multimodal imaging of optic nerve head abnormalities in high myopia

“…This helps differentiate PlCC from pigment epithelial detachment, peripapillary choroidal neovascularization, and other potentially confounding entities. Meanwhile, ICGA demonstrates absent choroidal flow, resulting in hypofluorescence throughout the sequence ( 55 ).…”