Focal choroidal excavation (FCE) is a concavity in the

choroid The choroid, also known as the choroidea or choroid coat, is a part of the uvea, the vascular layer of the eye, and contains connective tissues, and lies between the retina and the sclera. The human choroid is thickest at the far extreme rear ...

al layer of the eye that can be detected by

optical coherence tomography Optical coherence tomography (OCT) is an imaging technique that uses low-coherence light to capture micrometer-resolution, two- and three-dimensional images from within optical scattering media (e.g., biological tissue). It is used for medical ...

. The disease is usually unilateral and not associated with any accompanying systemic diseases.

Pathophysiology

Focal choroidal excavation (FCE) is a concavity in the

al layer of the eye without posterior

staphyloma A staphyloma is an abnormal protrusion of the uveal tissue through a weak point in the eyeball. The protrusion is generally black in colour, due to the inner layers of the eye. It occurs due to weakening of outer layer of eye (cornea or sclera) by ...

or scleral ectasia, that can be detected by

. The concavity is commonly seen in the

macula The macula (/ˈmakjʊlə/) or macula lutea is an oval-shaped pigmented area in the center of the retina of the human eye and in other animals. The macula in humans has a diameter of around and is subdivided into the umbo, foveola, foveal avas ...

r region. The disease is usually unilateral and not associated with any accompanying systemic diseases. Choroidal vascular disorders which cause visual symptoms, including central serous chorioretinopathy (CSCR),

choroidal neovascularization Choroidal neovascularization (CNV) is the creation of new blood vessels in the choroid layer of the eye. Choroidal neovascularization is a common cause of neovascular degenerative maculopathy (i.e. 'wet' macular degeneration) commonly exacerbated ...

(CNV), and polypoidal choroidal vasculopathy (PCV) may also present with focal choroidal excavation.

Etiology

The exact etiology of FCE is still (as of 2022) unknown. It was previously considered a congenital disease, but later it was suggested that FCEs can also occur with choroidal atrophy and

choroiditis Chorioretinitis is an inflammation of the choroid (thin pigmented vascular coat of the eye) and retina of the eye. It is a form of posterior uveitis. If only the choroid is inflamed, not the retina, the condition is termed choroiditis. The ophthalm ...

Signs and symptoms

In FCE,

visual acuity Visual acuity (VA) commonly refers to the clarity of vision, but technically rates an examinee's ability to recognize small details with precision. Visual acuity is dependent on optical and neural factors, i.e. (1) the sharpness of the retinal ...

may be normal and the overlying retina may also appear normal.

Classification

There are three types of classification systems used to classify FCE. If there is no separation between photoreceptor outer segments and the

retinal pigment epithelium The pigmented layer of retina or retinal pigment epithelium (RPE) is the pigmented cell layer just outside the neurosensory retina that nourishes retinal visual cells, and is firmly attached to the underlying choroid and overlying retinal visual ce ...

(RPE), it is classified as conforming and if there is a space it is considered as non-conforming. Based on shape of the choroidal concavity FCE can be classified as cone-shaped, bowl-shaped, or mixed morphology. Based on the location of the lesion, it can be classified as

foveal The fovea centralis is a small, central pit composed of closely packed cones in the eye. It is located in the center of the macula lutea of the retina. The fovea is responsible for sharp central vision (also called foveal vision), which is ...

or extrafoveal.

Treatment

Asymptomatic FCE without any other choroidal or retinal changes, observation is only recommended. If the lesion expands or the

sclera The sclera, also known as the white of the eye or, in older literature, as the tunica albuginea oculi, is the opaque, fibrous, protective, outer layer of the human eye containing mainly collagen and some crucial elastic fiber. In humans, and som ...

thickens, rule out other underlying causes and treat it.

History

Jampol et al. first identified the lesion in 2006. Margolis et al. named the condition as focal choroidal excavation. Later Shinojima et al. described a classification system based on shape of the choroidal concavity.

References

{{DEFAULTSORT:Focal choroidal excavation Disorders of choroid and retina