Purpose: To report multimodal imaging features of an unusual case of multiple focal choroidal excavations (FCE) associated to macular intrachoroidal cavitations (ICC) and choroidal neovascularization (CNV) in a non-myopic patient with normal choroidal thickness. Methods: Observational case report. Results: A 69-year-old non-myopic male patient with history of macular CNV of unknown etiology in the right eye (RE), initially treated with Bevacizumab intravitreal injections with significant improvement of visual acuity. He presented with acute vision loss in the same eye related to recurrent CNV exudation. Multimodal imaging of the RE confirmed the diagnosis of active type 2 CNV, associated to multiple FCE. Besides, it highlighted incidental unusual macular ICC in the same eye. Choroidal thickness was within normal limits (217 μm). Conclusion: Focal choroidal excavations and intrachoroidal cavitations can be observed in emmetropic patients in the absence of pachychoroid disease. In presence of CNV of unknown etiology, complete multimodal imaging can be of a great help to better define choroidal anomalies, allowing structural and vascular correlations between different lesions. Key words: Focal choroidal excavation; Choroidal cavitation; Multimodal imaging
JampolLMShankleJSchroederR, et al.Diagnostic and therapeutic challenges. Retina2006; 26: 1072–1076.
2.
Castro-NavarroVBehar-CohenFChangW, et al.Pachychoroid: current concepts on clinical features and pathogenesis. Graefes Arch Clin Exp Ophthalmol2021; 259: 1385–1400.
3.
ChungHByeonSHFreundKB. Focal choroidal excavation and its association with pachychoroid spectrum disorders: a review of the literature and multimodal imaging findings. Retina2017; 37: 199–221.
4.
InancMTekinKTekeMY, et al.Tomographic characteristics of focal choroidal excavation and its association with retinal disorders. Eur J Ophthalmol2021; 31: 1154–1160.
5.
MatsubaraHUchiyamaESuzukiK, et al.A case of focal choroidal excavation development associated with multiple evanescent white dot syndrome. Case Rep Ophthalmol2018; 9: 388–394.
6.
Battaglia ParodiMCasalinoGIaconoP, et al.The expanding clinical spectrum of choroidal excavation in macular dystrophies. Retina2018; 38: 2030–2034.
7.
PierroLMarcheseAGagliardiM, et al.Choroidal excavation in choroidal osteoma complicated by choroidal neovascularization. Eye (Lond)2017; 31: 1740–1743.
8.
ShahRCGopalakrishnanMGoyalA, et al.Focal choroidal excavation: cause or effect?Indian J Ophthalmol2019; 67: 696–698.
9.
GalvinJCFungAT. Focal choroidal excavation and choroidal neovascularization: the chicken and the egg. Clin Experiment Ophthalmol2020; 48: 839–840.
10.
KovacsKDGonzalezLAWeissSJ, et al.Focal choroidal excavation expansion following treatment of associated choroidal neovascular membrane. Ophthalmic Surg Lasers Imaging Retina2019; 51: 54–57.
11.
Ohno-MatsuiKAkibaMMoriyamaM, et al.Intrachoroidal cavitation in macular area of eyes with pathologic myopia. Am J Ophthalmol2012; 154: 382–393.
12.
MargolisRMukkamalaSKJampolLM, et al.The expanded spectrum of focal choroidal excavation. Arch Ophthalmol (Chicago, Ill 1960)2011; 129: 1320–1325.
13.
XuHZengFShiD, et al.Focal choroidal excavation complicated by choroidal neovascularization. Ophthalmology2014; 121: 246–250.
GhadialiQDansinganiKKFreundKB. Focal choroidal excavation and choroidal neovascularization with associated pachychoroid. Retin Cases Brief Rep2016; 10: 293–296.
16.
ManayathGVergheseSRanjanR, et al.Simultaneous multiple pachychoroid spectrum entities coexisting in the same eye. Indian J Ophthalmol2020; 68: 2234.
17.
LeeJHLeeWK. Choroidal neovascularization associated with focal choroidal excavation. Am J Ophthalmol2014; 157: 710–8.e1.
18.
SatoTYasukawaTHayashiK. Focal choroidal excavation disappearing after successful treatment of type 2 choroidal neovascularization with intravitreal aflibercept. Am J Ophthalmol Case Reports2021; 22: 101078.
19.
FreundKBCiardellaAPYannuzziLA, et al. Peripapillary detachment in pathologic myopia.Arch Ophthalmol2003; 121: 197–204.
20.
ToranzoJCohenSYErginayA, et al. Peripapillary intrachoroidal cavitation in myopia.Am J Ophthalmol2005; 140: 731–732.
21.
Ohno-MatsuiKAkibaMMoriyamaM, et al. Intrachoroidal cavitation in macular area of eyes with pathologic myopia.Am J Ophthalmol2012; 154: 382–393.
22.
WeiYHYangCMChenMS, et al. Peripapillary intrachoroidal cavitation in high myopia: reappraisal.Eye2009; 23: 141–144.
