A 6-year-old boy presented with a history of itching and redness in both eyes. The best-corrected visual acuity (BCVA) was 20/20 in both eyes on examination. The intraocular pressure (IOP) measured by noncontact tonometry was normal. Anterior segment examination revealed signs of bilateral allergic conjunctivitis. On fundus evaluation, the right eye was normal, while the left eye revealed focal pigmentary changes inferior to fovea Fig. 1.Figure 1: Color fundus photography of the left eye showing focal pigmentary changes adjacent to fovea (yellow arrow)Optical coherence tomography (OCT) was performed, revealing a cup-shaped focal choroidal excavation in the parafoveal region with disorganization of the outer retinal layers and overlying retinal pigment epithelium within the excavated region Fig. 2. The patient was treated conservatively, and a periodic evaluation every 6 months with serial photography and repeat OCT was recommended.Figure 2: Optical coherence tomography (Retina Scan Duo™ 2, Nidek) showing a nonconforming focal choroidal excavation (yellow arrow) with space between photoreceptors and RPE (red star)Discussion Focal choroidal excavation (FCE) is a recently characterized clinical entity first described by Jampol in 2006 and coined as a term by Margolis in 2011.1,2 It is identified as an area of concavity in the choroid with associated focal choroidal thinning on optical coherence tomography.2 Most FCEs are found in the macular region without associated posterior staphyloma or scleral ectasia. It is typically unilateral; however, bilateral cases have been reported. Although the exact cause is still unknown, careful examination of the choroid should be performed in all eyes with FCE as a majority of cases are associated with conditions such as CSC, PCV, choroidal inflammation, and choroidal dystrophies, which might require treatment at presentation or in future.3 FCE can be present at any age; the majority are found in adults secondary to a pathology (acquired type). Sivalingam et al.described the progression of combined hamartoma of the retina and retinal pigment epithelium detected at 19 months of age to an FCE, which was observed at 14 years.4 We report a case of rare occurrence of FCE at a relatively young age (6 years), which can be a congenital abnormality or secondary to an unidentified disease process. Since it is an OCT-based diagnosis, it is classified as either conforming or nonconforming. “Conforming FCEs” are those in which the photoreceptor and underlying RPE are not separated. However, “nonconforming FCEs” have a separation, or hypo reflective space, between the tips of photoreceptors and the RPE.2 FCE alone does not warrant any treatment due to minimal effect on vision and mostly stable natural history. Authors contributions Bhanu Priya: Literature search, manuscript preparation, manuscript editing; Gaganjeet Singh Gujral: Concept, design, data acquisition, definition of intellectual content; Anjali Mehta: Data acquisition. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, patient have given his consent for his images and other clinical information to be reported in the journal. The patient understand that their names and initials will not be published and due effort will be made to conceal their identity, but anonymity can not be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.
Gujral et al. (Thu,) studied this question.