Comparison and correlation analysis of clinical and imaging features of focal choroidal excavation_Chinese Journal of Ocular Fundus Diseases

Authors：

Liu Pei ¹ , Li Shu ¹ , Lu Chenyu ¹ , An Guangqi ¹ , Jin Bo ^1,2 , Du Liping ^1,2 ,  Jin Xuemin ^1,2

1. The First Affiliated Hospital of Zhengzhou University, Henan Provincial Eye Hospital, Zhengzhou University School of Medical Sciences, Zhengzhou 450003, China;
2. Institute of Fundus Diseases, Zhengzhou University, Zhengzhou 450000, China;

Corresponding author：

Jin Xuemin, Email: 2740913223@qq.com

Keywords：

Focal choroidal invagination; Central serous chorioretinal disease; Punctate inner choroidopathy; Idiopathic choroidal neovascularization; Swept-source optical coherence tomography; Choroidal thickness

DOI：

10.3760/cma.j.cn511434-20240904-00330

Video：

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Objective To compare the clinical and imaging characteristics of eyes with idiopathic focal choroidal excavation (FCE) and acquired FCE, and to preliminarily analyze the association of FCE with different fundus diseases. Methods A retrospective clinical study. A total of 90 patients (93 eyes) diagnosed with FCE at the Ophthalmology Department of The First Affiliated Hospital of Zhengzhou University from March 2021 to May 2024 were included in the study. All affected eyes underwent best-corrected visual acuity (BCVA) testing, intraocular pressure (IOP) measurement, ophthalmoscope, fundus color photography, and swept-source optical coherence tomography (SS-OCT). SS-OCT was used to measure subfoveal choroidal thickness (SFCT), choroidal thickness at the temporal, nasal, and inferior margins of the FCE, as well as the maximum width and depth of the FCE. Based on the presence of concomitant fundus diseases, FCE cases were divided into an idiopathic FCE group (51 eyes) and an acquired FCE group (42 eyes). Clinical characteristics at the initial and final visits were compared between the two groups. Clinical features were also analyzed for acquired FCE eyes with different associated fundus diseases. A logistic regression model was used to identify potential risk factors for FCE coexisting with other fundus diseases. Results Compared to the idiopathic FCE group, the acquired FCE group had significantly decreased BCVA (Z=−8.290), significantly increased FCE width (Z=−2.762), and significantly higher incidence rates of saucer-shaped FCE (χ²=8.352) and ellipsoid zone disruption (χ²=7.999). These differences were all statistically significant (P＜0.05). No significant differences were found between the two groups in age, gender distribution, IOP, foveal involvement, proportion of conforming FCE, retinal pigment epithelium-Bruch’s membrane rupture, presence of hyperreflective material under the excavation, presence of surrounding thick vessels, FCE depth, SFCT, or choroidal thickness at the inferior, temporal, and nasal margins of the FCE (P＞0.05). Logistic regression analysis revealed that FCE width (odds ratio=1.002, 95% confidence interval: 1.001-1.004, P=0.005) was the sole risk factor for FCE coexisting with other fundus complications. In both the idiopathic and acquired FCE groups, FCE depth and width remained relatively stable during follow-up. BCVA improved in the acquired FCE group after treatment. Conclusions FCE can coexist with various fundus diseases. FCE width is the only risk factor for the development of other fundus complications in FCE-affected eyes. Treating retinal or choroidal diseases associated with acquired FCE can provide visual benefits to patients.

Citation： Liu Pei, Li Shu, Lu Chenyu, An Guangqi, Jin Bo, Du Liping, Jin Xuemin. Comparison and correlation analysis of clinical and imaging features of focal choroidal excavation. Chinese Journal of Ocular Fundus Diseases, 2025, 41(8): 622-629. doi: 10.3760/cma.j.cn511434-20240904-00330 Copy

1.	Jampol LM, Shankle J, Schroeder R, et al. Diagnostic and therapeutic challenges[J]. Retina, 2006, 26(9): 1072-1076. DOI: 10.1097/01.iae.0000248819.86737.a5.
2.	Gan Y, Ji Y, Zuo C, et al. Correlation between focal choroidal excavation and underlying retinochoroidal disease: a pathological hypothesis from clinical observation[J]. Retina, 2022, 42(2): 348-356. DOI: 10.1097/IAE.0000000000003307.
3.	Iacono P, Battaglia PM, Saviano S, et al. Large choroidal excavation in pachychoroid disease: a case report[J]. Eur J Ophthalmol, 2021, 31(2): 15-17. DOI: 10.1177/1120672119892428.
4.	Chung H, Byeon SH, Freund KB. Focal choroidal excavation and its association with pachychoroid spectrum disorders: a review of the literature and multimodal imaging findings[J]. Retina, 2017, 37(2): 199-221. DOI: 10.1097/IAE.0000000000001345.
5.	Shinojima A, Kawamura A, Mori R, et al. Morphologic features of focal choroidal excavation on spectral domain optical coherence tomography with simultaneous angiography[J]. Retina, 2014, 34(7): 1407-1414. DOI: 10.1097/IAE.0000000000000108.
6.	Okubo A, Okamoto F, Uezono K, et al. Visual functions and multimodal imaging of patients with idiopathic focal choroidal excavation[J/OL]. Sci Rep, 2024, 14(1): 13236[2024-06-09]. https://pubmed.ncbi.nlm.nih.gov/38853166/. DOI: 10.1038/s41598-024-63866-3.
7.	Lee CS, Woo SJ, Kim YK, et al. Clinical and spectral-domain optical coherence tomography findings in patients with focal choroidal excavation[J]. Ophthalmology, 2014, 121(5): 1029-1035. DOI: 10.1016/j.ophtha.2013.11.043.
8.	Wakabayashi Y, Nishimura A, Higashide T, et al. Unilateral choroidal excavation in the macula detected by spectral-domain optical coherence tomography[J/OL]. Acta Ophthalmol, 2010, 88(3): e87-e91[2010-05-01]. https://pubmed.ncbi.nlm.nih.gov/20546234/. DOI: 10.1111/j.1755-3768.2010.01895.x.
9.	Park KA, Oh SY. The absence of focal choroidal excavation in children and adolescents without retinal or choroidal disorders or ocular trauma[J]. Eye (Lond), 2015, 29(6): 841-842. DOI: 10.1038/eye.2015.6.
10.	Rajabian F, Arrigo A, Jampol LM, et al. Optical coherence tomography angiography features of focal choroidal excavation and the choroidal stroma variations with occurrence of excavation[J]. Retina, 2020, 40(12): 2319-2324. DOI: 10.1097/IAE.0000000000002765.
11.	Chew EY, Clemons TE, Jaffe GJ, et al. Effect of ciliary neurotrophic factor on retinal neurodegeneration in patients with macular telangiectasia type 2: a randomized clinical trial[J]. Ophthalmology, 2019, 126(4): 540-549. DOI: 10.1016/j.ophtha.2018.09.041.
12.	叶祖科, 尹小芳, 罗书科, 等. 局限性脉络膜凹陷患眼多模式影像特征观察及发生并发症的危险因素分析[J]. 中华眼底病杂志, 2019, 35(4): 342-347. DOI: 10.3760/cma.j.issn.1005-1015.2019.04.006.Ye ZK, Yin XF, Luo SK, et al. Multimodal imaging characteristics of focal choroidal excavation and risk factors analysis of its complications[J]. Chin J Ocul Fundus Dis, 2019, 35(4): 342-347. DOI: 10.3760/cma.j.issn.1005-1015.2019.04.006.
13.	Capellan P, Gonzalez LA, Abdallah Mahrous M, et al. Primary and secondary focal choroidal excavation morphologic phenotypes, associated ocular disorders and prognostic implications[J]. Br J Ophthalmol, 2023, 107(3): 373-379. DOI: 10.1136/bjophthalmol-2021-319569.
14.	Ellabban AA, Tsujikawa A, Ooto S, et al. Focal choroidal excavation in eyes with central serous chorioretinopathy[J]. Am J Ophthalmol, 2013, 156(4): 673-683. DOI: 10.1016/j.ajo.2013.05.010.
15.	Hwang BE, Kim JY, Kim RY, et al. En-face optical coherence tomography hyperreflective foci of choriocapillaris in central serous chorioretinopathy[J/OL]. Sci Rep, 2023, 13(1): 7184[2023-05-03]. https://pubmed.ncbi.nlm.nih.gov/37137948/. DOI: 10.1038/s41598-023-33800-0.
16.	Imanaga N, Terao N, Sonoda S, et al. Relationship between scleral thickness and choroidal structure in central serous chorioretinopathy[J]. Invest Ophthalmol Vis Sci, 2023, 64(1): 16. DOI: 10.1167/iovs.64.1.16.
17.	Lee JH, Lee WK. Choroidal neovascularization associated with focal choroidal excavation[J]. Am J Ophthalmol, 2014, 157(3): 710-718. DOI: 10.1016/j.ajo.2013.12.011.
18.	Seo EJ, Moon TH, Kim DY, et al. Choroidal inflammation and choriocapillaris ischemia in focal choroidal excavation in comparison to pachychoroid neovasculopathy[J]. Retina, 2021, 41(5): 987-996. DOI: 10.1097/IAE.0000000000002980.
19.	Rajabian F, Arrigo A, Grazioli A, et al. Focal choroidal excavation and pitchfork sign in choroidal neovascularisation associated with choroidal osteoma[J]. Eur J Ophthalmol, 2021, 31(2): 67-70. DOI: 10.1177/1120672119892802.
20.	Pierro L, Marchese A, Gagliardi M, et al. Choroidal excavation in choroidal osteoma complicated by choroidal neovascularization[J]. Eye (Lond), 2017, 31(12): 1740-1743. DOI: 10.1038/eye.2017.136.
21.	Fayyad OF, Al-Hashimi MR, Fayyad FT. A case of full-thickness macular hole in eye with focal choroidal excavation[J]. Retin Cases Brief Rep, 2018, 12(4): 291-293. DOI: 10.1097/ICB.0000000000000497.

1. Jampol LM, Shankle J, Schroeder R, et al. Diagnostic and therapeutic challenges[J]. Retina, 2006, 26(9): 1072-1076. DOI: 10.1097/01.iae.0000248819.86737.a5.
2. Gan Y, Ji Y, Zuo C, et al. Correlation between focal choroidal excavation and underlying retinochoroidal disease: a pathological hypothesis from clinical observation[J]. Retina, 2022, 42(2): 348-356. DOI: 10.1097/IAE.0000000000003307.
3. Iacono P, Battaglia PM, Saviano S, et al. Large choroidal excavation in pachychoroid disease: a case report[J]. Eur J Ophthalmol, 2021, 31(2): 15-17. DOI: 10.1177/1120672119892428.
4. Chung H, Byeon SH, Freund KB. Focal choroidal excavation and its association with pachychoroid spectrum disorders: a review of the literature and multimodal imaging findings[J]. Retina, 2017, 37(2): 199-221. DOI: 10.1097/IAE.0000000000001345.
5. Shinojima A, Kawamura A, Mori R, et al. Morphologic features of focal choroidal excavation on spectral domain optical coherence tomography with simultaneous angiography[J]. Retina, 2014, 34(7): 1407-1414. DOI: 10.1097/IAE.0000000000000108.
6. Okubo A, Okamoto F, Uezono K, et al. Visual functions and multimodal imaging of patients with idiopathic focal choroidal excavation[J/OL]. Sci Rep, 2024, 14(1): 13236[2024-06-09]. https://pubmed.ncbi.nlm.nih.gov/38853166/. DOI: 10.1038/s41598-024-63866-3.
7. Lee CS, Woo SJ, Kim YK, et al. Clinical and spectral-domain optical coherence tomography findings in patients with focal choroidal excavation[J]. Ophthalmology, 2014, 121(5): 1029-1035. DOI: 10.1016/j.ophtha.2013.11.043.
8. Wakabayashi Y, Nishimura A, Higashide T, et al. Unilateral choroidal excavation in the macula detected by spectral-domain optical coherence tomography[J/OL]. Acta Ophthalmol, 2010, 88(3): e87-e91[2010-05-01]. https://pubmed.ncbi.nlm.nih.gov/20546234/. DOI: 10.1111/j.1755-3768.2010.01895.x.
9. Park KA, Oh SY. The absence of focal choroidal excavation in children and adolescents without retinal or choroidal disorders or ocular trauma[J]. Eye (Lond), 2015, 29(6): 841-842. DOI: 10.1038/eye.2015.6.
10. Rajabian F, Arrigo A, Jampol LM, et al. Optical coherence tomography angiography features of focal choroidal excavation and the choroidal stroma variations with occurrence of excavation[J]. Retina, 2020, 40(12): 2319-2324. DOI: 10.1097/IAE.0000000000002765.
11. Chew EY, Clemons TE, Jaffe GJ, et al. Effect of ciliary neurotrophic factor on retinal neurodegeneration in patients with macular telangiectasia type 2: a randomized clinical trial[J]. Ophthalmology, 2019, 126(4): 540-549. DOI: 10.1016/j.ophtha.2018.09.041.
12. 叶祖科, 尹小芳, 罗书科, 等. 局限性脉络膜凹陷患眼多模式影像特征观察及发生并发症的危险因素分析[J]. 中华眼底病杂志, 2019, 35(4): 342-347. DOI: 10.3760/cma.j.issn.1005-1015.2019.04.006.Ye ZK, Yin XF, Luo SK, et al. Multimodal imaging characteristics of focal choroidal excavation and risk factors analysis of its complications[J]. Chin J Ocul Fundus Dis, 2019, 35(4): 342-347. DOI: 10.3760/cma.j.issn.1005-1015.2019.04.006.
13. Capellan P, Gonzalez LA, Abdallah Mahrous M, et al. Primary and secondary focal choroidal excavation morphologic phenotypes, associated ocular disorders and prognostic implications[J]. Br J Ophthalmol, 2023, 107(3): 373-379. DOI: 10.1136/bjophthalmol-2021-319569.
14. Ellabban AA, Tsujikawa A, Ooto S, et al. Focal choroidal excavation in eyes with central serous chorioretinopathy[J]. Am J Ophthalmol, 2013, 156(4): 673-683. DOI: 10.1016/j.ajo.2013.05.010.
15. Hwang BE, Kim JY, Kim RY, et al. En-face optical coherence tomography hyperreflective foci of choriocapillaris in central serous chorioretinopathy[J/OL]. Sci Rep, 2023, 13(1): 7184[2023-05-03]. https://pubmed.ncbi.nlm.nih.gov/37137948/. DOI: 10.1038/s41598-023-33800-0.
16. Imanaga N, Terao N, Sonoda S, et al. Relationship between scleral thickness and choroidal structure in central serous chorioretinopathy[J]. Invest Ophthalmol Vis Sci, 2023, 64(1): 16. DOI: 10.1167/iovs.64.1.16.
17. Lee JH, Lee WK. Choroidal neovascularization associated with focal choroidal excavation[J]. Am J Ophthalmol, 2014, 157(3): 710-718. DOI: 10.1016/j.ajo.2013.12.011.
18. Seo EJ, Moon TH, Kim DY, et al. Choroidal inflammation and choriocapillaris ischemia in focal choroidal excavation in comparison to pachychoroid neovasculopathy[J]. Retina, 2021, 41(5): 987-996. DOI: 10.1097/IAE.0000000000002980.
19. Rajabian F, Arrigo A, Grazioli A, et al. Focal choroidal excavation and pitchfork sign in choroidal neovascularisation associated with choroidal osteoma[J]. Eur J Ophthalmol, 2021, 31(2): 67-70. DOI: 10.1177/1120672119892802.
20. Pierro L, Marchese A, Gagliardi M, et al. Choroidal excavation in choroidal osteoma complicated by choroidal neovascularization[J]. Eye (Lond), 2017, 31(12): 1740-1743. DOI: 10.1038/eye.2017.136.
21. Fayyad OF, Al-Hashimi MR, Fayyad FT. A case of full-thickness macular hole in eye with focal choroidal excavation[J]. Retin Cases Brief Rep, 2018, 12(4): 291-293. DOI: 10.1097/ICB.0000000000000497.

Chinese Journal of Ocular Fundus Diseases

Comparison and correlation analysis of clinical and imaging features of focal choroidal excavation

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