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Primary and secondary focal choroidal excavation morphologic phenotypes, associated ocular disorders and prognostic implications
  1. Pamela Capellan,
  2. Luis A Gonzalez,
  3. M Abdallah Mahrous,
  4. Stephanie J Weiss,
  5. Benjamin Botsford,
  6. Tamara L Lenis,
  7. Michael Ryan,
  8. Anton Orlin,
  9. Thanos Papakostas,
  10. Szilard Kiss,
  11. Donald D'Amico,
  12. Kyle Kovacs
  1. Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
  1. Correspondence to Kyle Kovacs, Department of Ophthalmology, Weill Cornell Medical College, New York, USA; kyle.kovacs{at}


Aims To characterise and classify the morphological, clinical and tomographic characteristics of focal choroidal excavation (FCE) lesions to determine their prognostic implications.

Methods 36 eyes with FCE (32 patients) underwent multimodal imaging, including spectral domain optical coherence tomography and fundus autofluorescence. FCE lesions were classified into three subtypes: (1) type 1: myopic (central choroidal thickness: <100 µm), (2) type 2: suspected congenital (central choroidal thickness: 100–200 µm, without associated chorioretinal pathology) and (3) type 3: secondary or acquired (central choroidal thickness: >200 µm, with associated chorioretinal pathology).

Results 80.6% of eyes were followed longitudinally (26.8±18.8 months). There were 9 type 1 FCEs (myopic), 8 type 2 FCEs (U-shaped, congenital) and 19 type 3 FCEs (V-shaped, secondary). Type 2 FCEs trended towards larger maximum widths (p=0.0563). Type 3 FCEs were associated with central serous chorioretinopathy or pachyvessels (47.4%), but were also seen in pattern dystrophy, geographic atrophy, inactive choroiditis, torpedo maculopathy and adult-onset vitelliform dystrophy. Choroidal neovascular membranes (CNVMs) were more prevalent in type 3 FCE (41.2% compared with 11.1% for type 1 FCE, p=0.251, and 0% for type 2 FCE, p=0.043).

Conclusions The FCE types, stratified by central choroidal thickness, demonstrated distinct morphological characteristics and associated findings. The classification scheme held prognostic implications as type 3 FCE with V shapes were associated with other chorioretinal conditions and were more likely to develop CNVM.

  • retina
  • vision
  • imaging
  • macula
  • choroid

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Presented at The content of this study was presented at the annual meeting for the Association for Research in Vision and Ophthalmology, 2–5 May 2021.

  • Contributors KK designed and planned the study, performed the statistical analysis and data analysis, and critical revision of the manuscript. KK is responsible for the overall content of the manuscript and is guarantor of the study. PC, LAG, MAM, SJW, BB, TLL and MR collected data and aided in interpretation of said data and critical revision of the manuscript. AO, TP, SK and DD'A aided in the conceptual development of the study, study design, data acquisition and interpretation. PC constructed the manuscript. All authors participated in the critical revision of the manuscript, approved the submitted manuscript and are in agreement to be held accountable for every aspect of the work.

  • Funding This study was supported, in part, by an unrestricted department grant (Department of Ophthalmology, Weill Cornell Medicine) from Research to Prevent Blindness. There is no associated award or fund number.

  • Competing interests KK: consultant for Regenxbio. DD’A: consultant—Alcon, IVERIC bio and Aufbau Holdings; equity—IVERIC bio and Aufbau Holdings; intellectual property—Aufbau Holdings. Szilárd Kiss: consultant—Adverum, Alcon, Novartis, Optos and Genentech/Roche; research funding—Allergan, Novartis, Optos, Genentech/Roche and Regeneron; equity—Adverum, Regenxbio and Fortress Bio; intellectual property—gene therapy for age-related macular degeneration and T cells for CMV retinitis, assigned to Cornell University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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