Sequence of focal choroidal excavation types in a patient with bilateral central serous chorioretinopathy

ABSTRACT A 39-year-old policeman complained of decreased bilateral central vision over the last two years. On examination, visual acuity was 20/40 and 20/400 in the right (OD) and left eye (OS), respectively, and fundoscopy revealed a bilateral hypopigmented macular lesion. Fluorescein and indocyanine green angiography demonstrated leakage and hyperintense spots, respectively, within the macular areas. At baseline, optical coherence tomography showed subretinal fluid in the OD and a conforming focal choroidal excavation in the OS. Focal choroidal excavation converted from conforming to nonconforming type at 4-month follow-up and then reversed to conforming type at 12-month follow-up, and was associated with incomplete retinal pigment epithelium and outer retina atrophy over the area of excavation. Pachyvessels were also evidenced in the choroid, without neovascularization. We report for the first time a case of focal choroidal excavation that progressed from conforming to nonconforming type and then reverted to its primary configuration (conforming type) in a patient with concurrent bilateral central serous chorioretinopathy.

摘要 39岁警务人员自述近2年来双眼中心视力下降。眼科检查显示：右眼（OD，oculus dexter）与左眼（OS，oculus sinister）的裸眼视力分别为20/40与20/400；眼底镜检查可见双眼黄斑区色素减退性病灶。荧光素血管造影（fluorescein angiography）与吲哚菁绿血管造影（indocyanine green angiography）分别显示黄斑区存在渗漏与高荧光斑点。基线光学相干断层扫描（optical coherence tomography, OCT）结果示：右眼存在视网膜下积液，左眼可见符合型局限性脉络膜凹陷（focal choroidal excavation, FCE）。随访4个月时，该局限性脉络膜凹陷由符合型转变为非符合型；至随访12个月时，其又恢复为符合型，且凹陷区域伴随视网膜色素上皮与外层视网膜不完全性萎缩。脉络膜可见粗大血管，未发现新生血管形成。本文首次报告1例同时合并双眼中心性浆液性脉络膜视网膜病变（central serous chorioretinopathy, CSC）的患者，其局限性脉络膜凹陷经历了由符合型向非符合型转变，随后又恢复至初始符合型的病程。