This 60YO female has a history of idiopathic central serous chorioretinopathy that was previously treated successfully with photodynamic therapy in her left eye. Bilateral macular drusen are noted.
OCT shows a definite focal choroidal excavation (FCE) in her right eye, and a possible FCE in her left eye.
Learning Points:
Focal choroidal excavation, originally described by Jampol et al. in 2006, is likely part of the pachychoroid spectrum, as it is usually associated with a thickened choroid and pachyvessels.
The FCE can be observed, although symptomatic manifestations, including active central serous retinopathy or macular neovascularization, often require treatment.
Spaide and Ryan noted this finding in about two-thirds of patients with central serous retinopathy (Am J Ophthalmology 2015;160;1211-1216). An excellent review is by Chung et al (Retina 2017;37;199-221).
