Focal choroidal excavation disappearing after successful treatment of type 2 choroidal neovascularization with intravitreal aflibercept





Abstract


Purpose


To report a case with focal choroidal excavation (FCE) accompanied by type 2 choroidal neovascularization (CNV), in which the CNV was successfully treated with intravitreal aflibercept, after which the FCE was no longer detectable.


Observations


A conforming type of FCE was detected in the left eye of a 34-year-old Japanese man who visited our hospital for a second opinion regarding treatment for his right eye. Three months later, type 2 CNV developed in the region corresponding to the FCE in the left eye. After treatment with intravitreal aflibercept, the CNV disappeared, and FCE was no longer detected. No recurrence has been observed in the 12 months following the treatment.


Conclusions and Importance


Although the etiology of FCE has not been fully elucidated, we discussed the mechanisms underlying its occurrence, its association with CNV, and the disappearance of both conditions after treatment.


Highlights





  • Focal choroidal excavation (FCE) is a relatively rare clinical entity.



  • The etiology of FCE has not yet been fully elucidated.



  • We experienced FCE disappearance after treatment of choroidal neovascularization.



  • We speculate on the mechanism of FCE development and disappearance in this case.




Introduction


Focal choroidal excavation (FCE), first described by Jampol et al., in 2006, is a relatively rare clinical entity according to optical coherence tomography findings. FCE is characterized by a localized area of excavation of the choroid without any evidence of either posterior staphyloma or scleral ectasia. In the conforming type of FCE, the outer segments of the photoreceptors are attached to a concave retinal pigment epithelium (RPE), while in the nonconforming type, there exists a separation between the photoreceptor tips and the RPE. In most cases, FCE is relatively stable; however, it can be associated with comorbidities, such as central serous chorioretinopathy and age-related macular degeneration (AMD), including polypoidal choroidal vasculopathy. Additionally, it has recently been proposed that FCE should be included in the pachychoroid spectrum. ,


Here, we report a case with FCE accompanied by choroidal neovascularization (CNV) in a 34-year-old Japanese man. In this case, CNV was successfully treated with intravitreal aflibercept (IVA; Eylea®, Leverkusen, Germany), after which the FCE was no longer detected.



Case report


The patient visited our hospital to obtain a second opinion about treatment for his right eye. He had noticed decreased vision in the right eye 3 months earlier. At the first visit, his best-corrected visual acuity (BCVA) was 20/70 in the right eye (spherical equivalent: 4.375 diopters) and 20/16 in the left eye (spherical equivalent: 3.875 diopters). Cicatrized subretinal neovascularization without subretinal fluid or intraretinal cystic changes was noted in the right eye, whereas the conforming type of FCE was detected 500 μm temporal to the foveal in the left eye ( Fig. 1 ). He had smoked cigarettes for 15 years. There was no remarkable family medical history. General examination did not reveal any systemic abnormality.




Fig. 1


Fundus photographs showing subretinal cicatrized neovascularization in the right eye (A) and focal pigmentary changes in the left eye (B) of a 34-year-old male patient. Fundus autofluorescence images showing hypo- and hyper-autofluorescence corresponding to the cicatrized neovascularization in the right eye (C) and hypo-autofluorescence corresponding to the pigmentary changes in the left eye (D). Swept-source optical coherence tomography images showing subretinal cicatrized neovascularization in the right eye (E and G) and conforming type of focal choroidal excavation 500 μm distal to the fovea in the left eye (F and H).


Three months later, he re-visited our hospital due to decreased vision in the left eye. The BCVA had decreased to 20/30 in the left eye. Ophthalmic examination confirmed type 2 CNV with subretinal fluid in the region corresponding to the FCE in the left eye ( Fig. 2 ). After obtaining informed consent for the procedure, IVA was performed monthly for 3 months in the left eye. The study was conducted with the approval of the Institutional Review Board of Hayashi Eye Hospital and adhered to the tenets of the Declaration of Helsinki.




Fig. 2


Fundus photograph and autofluorescence image of the left eye showing an exudative lesion (A) and its corresponding hypoautofluorescence (B). Fluorescein (C) and indocyanine green (D) angiography images of the left eye showing fluorescein dye leakage in the center of the macula. Swept-source optical coherence tomography image of the left eye showing type 2 choroidal neovascularization arising from the location corresponding to the focal choroidal excavation, accompanied by subretinal fluid (E and F). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

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Jul 10, 2021 | Posted by in OPHTHALMOLOGY | Comments Off on Focal choroidal excavation disappearing after successful treatment of type 2 choroidal neovascularization with intravitreal aflibercept

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