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Okubo A, Okamoto F, Uezono K, Unoki K. Visual functions and multimodal imaging of patients with idiopathic focal choroidal excavation. Sci Rep 2024; 14:13236. [PMID: 38853166 PMCID: PMC11163001 DOI: 10.1038/s41598-024-63866-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 06/03/2024] [Indexed: 06/11/2024] Open
Abstract
This study aimed to evaluate visual function and perform multimodal imaging on patients with focal choroidal excavation without any chorioretinal disease (idiopathic focal choroidal excavation [iFCE]). Seventeen eyes of 15 patients with iFCE (8 men, 7 women; mean ± standard deviation age, 56.0 ± 10.8 years) were assessed for visual function including visual acuity, metamorphopsia, aniseikonia, and retinal sensitivity. Multimodal imaging included optical coherence tomography (OCT), fundus autofluorescence (FAF), and OCT angiography. This study found that the maximum width and depth of the excavation were 597 ± 330 (238-1809) µm and 123 ± 45 (66-231) µm, respectively, and that FAF showed normal or hypoautofluorescence corresponding to iFCE. The fundus examination findings were stable during the follow-up period (96 ± 48 months). None of the eyes showed any abnormalities in central retinal sensitivity or aniseikonia. Metamorphopsia was detected using Amsler grid testing and M-CHARTS in two eyes. Therefore, this study is the first to quantitatively and qualitatively study metamorphopsia of patients with iFCE. Our results showed that most patients with iFCE did not have visual impairments, despite the presence of morphological changes in the outer retina and choroid.
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Affiliation(s)
- Akiko Okubo
- Unoki Eye Clinic, Harara 1-7-15, Kagoshima City, Kagoshima, 890-0026, Japan.
| | - Fumiki Okamoto
- Department of Ophthalmology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kei Uezono
- Unoki Eye Clinic, Harara 1-7-15, Kagoshima City, Kagoshima, 890-0026, Japan
| | - Kazuhiko Unoki
- Unoki Eye Clinic, Harara 1-7-15, Kagoshima City, Kagoshima, 890-0026, Japan
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Maruyama-Inoue M, Yanagi Y, Mohamed S, Inoue T, Kitajima Y, Ikeda S, Kadonosono K. Hyperreflective material in patients with non-neovascular pachychoroid disease. BMC Ophthalmol 2023; 23:255. [PMID: 37280611 DOI: 10.1186/s12886-023-03011-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/01/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND This study aimed to report eleven cases of non-neovascular pachychoroid disease with hyperreflective material (HRM) that occurred in Japanese patients. METHODS A retrospective review of data from eleven patients who had non-neovascular retinal pigment epithelium (RPE) protrusion with HRM in the neurosensory retina between March 2017 and June 2022 was conducted. Clinical examination, color fundus photography, fluorescein angiography, spectral-domain optical coherence tomography (SD-OCT), and OCT angiography data were analyzed. Main outcome measures were patient characteristics, changes in SD-OCT findings, and symptom outcomes. RESULTS All cases had RPE protrusion and HRM with dilated choroidal veins, which were characteristic of pachychoroid disease. However, none of the cases had macular neovascularization (MNV). In 9 eyes (81.8%), HRM improved spontaneously without intervention and resulted in alterations in RPE, referred to as pachychoroid pigment epitheliopathy (PPE) or focal choroidal excavation (FCE). In these cases, symptoms such as metamorphopsia and distortion improved without treatment. In the remaining two cases (18.2%), HRM still persisted during the follow-up period. CONCLUSION There are some cases of non-neovascular pachychoroid disorder with HRM, which might be a new entity of pachychoroid spectrum disease or an early stage of PPE or FCE. These cases should not be misdiagnosed as MNV, and careful observation is necessary.
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Affiliation(s)
- Maiko Maruyama-Inoue
- Department of Ophthalmology and Micro-Technology, Yokohama City University, 4-57 Urafune-cho, Minami-ku, Kanagawa, 232 - 0024, Yokohama, Japan.
| | - Yasuo Yanagi
- Department of Ophthalmology and Micro-Technology, Yokohama City University, 4-57 Urafune-cho, Minami-ku, Kanagawa, 232 - 0024, Yokohama, Japan
| | - Shaheeda Mohamed
- Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Tatsuya Inoue
- Department of Ophthalmology and Micro-Technology, Yokohama City University, 4-57 Urafune-cho, Minami-ku, Kanagawa, 232 - 0024, Yokohama, Japan
| | - Yoko Kitajima
- Department of Ophthalmology and Micro-Technology, Yokohama City University, 4-57 Urafune-cho, Minami-ku, Kanagawa, 232 - 0024, Yokohama, Japan
| | - Shoko Ikeda
- Department of Ophthalmology and Micro-Technology, Yokohama City University, 4-57 Urafune-cho, Minami-ku, Kanagawa, 232 - 0024, Yokohama, Japan
| | - Kazuaki Kadonosono
- Department of Ophthalmology and Micro-Technology, Yokohama City University, 4-57 Urafune-cho, Minami-ku, Kanagawa, 232 - 0024, Yokohama, Japan
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Zhang W, Zhang Y, Xu J, Dan H, Li X, Song Z. A physical sign of pathological myopia: myopic scleral pit. BMC Ophthalmol 2023; 23:114. [PMID: 36949450 PMCID: PMC10031946 DOI: 10.1186/s12886-023-02847-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 03/08/2023] [Indexed: 03/24/2023] Open
Abstract
PURPOSE Myopic scleral pit (MSP) is a rare physical sign of pathological myopia (PM). The aim of this study was to summarize the clinical characteristics of MSP and analyze its correlation with PM. METHODS Eight cases with PM and MSP were enrolled in this study. Comprehensive ophthalmic examinations, including subjective refraction, slit-lamp biomicroscope, intraocular pressure, fundus photographs, A- and B-scan ultrasonography and spectral-domain optical coherence tomography, were performed. RESULTS All the patients had a long history of PM with visual impairment, long axial length, and myopia-related fundus degeneration. Mean axial length was 31.48 ± 2.17 mm. Mean size of MSP was 0.69 ± 0.29 optic disc diameter (PD). Mean logMAR BCVA was 1.21 ± 0.88 logMAR. Spearman correlation analysis showed that the logMAR BCVA had no correlation with the size of pits (P = 0.34). Fundus examination revealed a focal pale concave located in the sclera exposed area of retinal choroid atrophy was found in all cases. OCT showed a deep scleral pit where the retinal choroid was thin or absent, without retinal sensory detachment or sensory defect. CONCLUSIONS This study identified a rare scleral lesion in all eight individuals with PM, which was termed "myopic scleral pit". This phenomenon is different from focal choroidal excavation and posterior staphyloma.
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Affiliation(s)
- Wenhua Zhang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, Zhengzhou, 450003, Henan, China
| | - Yaping Zhang
- Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), Affiliated People's Hospital of Northwest University, Xi'an 710004, China
| | - Jingxuan Xu
- Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan Eye Hospital, Zhengzhou, 450003, Henan, China
| | - Handong Dan
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, Zhengzhou, 450003, Henan, China
| | - Xiaoli Li
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, Zhengzhou, 450003, Henan, China.
| | - Zongming Song
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, Zhengzhou, 450003, Henan, China.
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Almasoudi EA, Alzwaihri AS, Alqahtani AS. Persistent Macular Edema in a Pediatric Vogt-Koyanagi-Harada Disease Patient: A Case Report. Cureus 2022; 14:e29635. [DOI: 10.7759/cureus.29635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/05/2022] Open
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The Contemporary Role of Photodynamic Therapy in the Treatment of Pachychoroid Diseases. J Ophthalmol 2021; 2021:6590230. [PMID: 34725570 PMCID: PMC8556979 DOI: 10.1155/2021/6590230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022] Open
Abstract
Recent advances in retinal imaging technology have improved our understanding in the pathogenesis and evolvement of various chorioretinal diseases. Central serous chorioretinopathy and polypoidal choroidal vasculopathy are now recognized to belong to the same spectrum of disorders known as pachychoroid diseases. Pachychoroid diseases have similar pathogenesis pathway and common characteristics of thickened choroid, dilated outer choroidal vessels, and thinning of choriocapillaris. More disease entities have been identified to belong to this disease spectrum. Photodynamic therapy can induce choroidal hypoperfusion, remodeling of abnormal choroidal vessels, and reduction of choroidal congestion. It is known to be an effective treatment for chronic central serous chorioretinopathy and polypoidal choroidal vasculopathy. Many new studies are being performed to investigate its efficacy in other pachychoroid diseases. In this review, we provided an overview of the rationale, efficacy, and treatment strategies of photodynamic therapy in different pachychoroid diseases and discussed its role in the management along with other treatment modalities with most updated clinical evidence.
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Nassar S, Tarbett AK, Browning DJ. Choroidal Cavitary Disorders. Clin Ophthalmol 2020; 14:2609-2623. [PMID: 32982154 PMCID: PMC7490088 DOI: 10.2147/opth.s264731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/07/2020] [Indexed: 11/23/2022] Open
Abstract
The structure and functions of the choroid have been long acknowledged but the pathophysiology behind various anomalies has been difficult to understand until the advent of optical coherence tomography (OCT). With OCT imaging, choroidal cavitations appear as optically empty spaces between the outer retinal and choroidal layers with attenuation or loss of outer retinal layers. Choroidal cavitations are found in the posterior pole and seen in conditions such as pathologic myopia, north carolina macular dystrophy (NCMD), focal choroidal excavation (FCE), and torpedo maculopathy (TM). To date, these disorders have not been linked. A commonality they all share is malformation of the RPE-photoreceptor-choroid complex. The following report describes the differences and similarities of choroidal cavitation amongst the different retinal disorders and emphasizes the importance of multimodal imaging in the detection and management of potential complications.
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Affiliation(s)
- Sandra Nassar
- Eye Department, Charlotte Eye, Ear, Nose, and Throat Associates, Charlotte, NC 28210, USA
| | - Aaron K Tarbett
- Eye Department, WG Hefner VA Medical System, Salisbury, NC 28144, USA
| | - David J Browning
- Eye Department, Charlotte Eye, Ear, Nose, and Throat Associates, Charlotte, NC 28210, USA
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Verma S, Kumar V, Azad S, Bhayana AA, Surve A, Kumar S, Agarwal P, Chawla R, Venkatesh P. Focal choroidal excavation: review of literature. Br J Ophthalmol 2020; 105:1043-1048. [DOI: 10.1136/bjophthalmol-2020-316992] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/16/2020] [Accepted: 07/03/2020] [Indexed: 11/04/2022]
Abstract
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
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Kumar V, Chatra K. Fibrotic pillar leads to focal choroidal excavation in Best vitelliform dystrophy. Graefes Arch Clin Exp Ophthalmol 2018; 256:2083-2087. [PMID: 30171352 DOI: 10.1007/s00417-018-4120-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/26/2018] [Accepted: 08/23/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To study focal choroidal excavations in patients with Best vitelliform dystrophy using optical coherence tomography and their topographical relation with fibrotic pillars. METHODS This is a retrospective cross-sectional study of consecutive patients diagnosed with Best vitelliform dystrophy at a tertiary eye care center. Records of patients with Best vitelliform dystrophy were reviewed for best-corrected visual acuity, color fundus photographs, shortwave autofluorescence, optical coherence tomography, and electrooculogram with special emphasis on the presence of focal choroidal excavation (FCE) and fibrotic pillar. Main outcome measure was to study the fibrotic pillar in relation to the FCE. RESULTS Thirty-eight eyes of 19 patients with mean age of 34.6 years were enrolled in the study. FCE was seen in eight eyes of six patients. Two patients had bilateral FCE and all the FCEs were located in the area of vitelliform lesion. Six out of eight eyes with FCE were in vitelliruptive stage of disease; one was in pseudohypopyon stage and one in atrophic stage. A fibrotic pillar was seen lying directly above the FCE in seven eyes. In one eye, hyper-reflective material not amounting to fibrotic pillar was seen lying above the FCE. CONCLUSION A focal choroidal excavation in the setting of Best vitelliform dystrophy is seen predominantly in the vitelliruptive stage of the disease. Fibrotic pillars appear to play a role in the formation of these FCEs.
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Affiliation(s)
- Vinod Kumar
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Karthik Chatra
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029, India
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