To evaluate the prevalence and clinical features of focal choroidal excavation (FCE) in patients presenting with central serous chorioretinopathy (CSC).

This is a retrospective consecutive case series of consecutive patients with CSC who were referred for spectral domain optical coherence tomography (SD-OCT) between January 2010 and December

2011. Medical records were reviewed and clinical features including presence of FCE in SD-OCT, fluorescence angiography (FA), and indocyanine green angiography (ICGA) were studied.

Among the 116 CSC patients assessed, FCE was found in 11 eyes of 7 (6.0%) patients. FCE was associated with subretinal fluid in six eyes of six patients and serous pigment epithelial

corresponding to the FCE. After a mean follow-up of 16 months, visual acuity of all 11 eyes with FCE remained stable or improved at the last follow-up.

FCE is not an uncommon feature in patients with CSC and might be associated with choroidal hemodynamic disturbances.

Focal choroidal excavation (FCE) is defined as one or more focal excavations in the choroidal layer detected by optical coherence tomography (OCT), in which the overlying retina appeared to

be normal and was first reported by Jampol et al in 2006.1 Clinically, FCE appears as a small localized lesion with focal pigmentary changes in fundus examination. The exact etiology of FCE

remains unknown and is postulated to be an idiopathic congenital condition. Previous studies have described two patterns of FCE: the conforming type in which the outer retinal layers conform

to retinal pigment epithelial (RPE) alterations within the excavation; and the nonconforming type, in which there is separation between the outer retina and the RPE within the excavation.2,

3

Since the first description of FCE, FCE has been found to be associated with a number of conditions including central serious chorioretinopathy (CSC), polypoidal choroidal vasculopathy

(PCV), choroidal neovascularization (CNV), and age-related macular degeneration (AMD).2, 3, 4, 5, 6 In particular, there appeared to be a higher prevalence of FCE in patients with CSC.3, 4,

5, 6, 7 The aim of this study is to evaluate the prevalence, clinical features and outcome of FCE in patients presenting with CSC.

This was a retrospective study of consecutive cases with a clinical diagnosis of CSC confirmed by spectral domain OCT (SD-OCT) assessment in the Hong Kong Eye Hospital between January 2010

and December 2011. The study adhered to the Declaration of Helsinki and was approved by the local Ethics Committee. The medical notes of the patents were reviewed and clinical data such as

visual acuity, ophthalmoscopic findings, SD-OCT, fundus autofluorescence (FAF) imaging, fluorescein angiography (FA), and indocyanine green angiography (ICGA) findings were recorded. SD-OCT,

FA, and ICGA were performed using the Spectralis HRA-OCT system (Heidelberg Engineering, Heidelberg, Germany). Snellen visual acuity was converted to logarithm of the minimum angle of

resolution (logMAR) units for statistical analysis. Statistical analysis was performed using a statistical software (StatPlus:Mac 2009, AnalystSoft Inc., Vancouver, BC, Canada). Demographic

characteristics of the patients were summarized by descriptive statistics. Comparisons of continuous variables were performed using Mann–Whitney U-test or Wilcoxon sign-ranked test. A

P-value of