Multimodal Imaging Evaluations of Focal Choroidal Excavations in Eyes with Central Serous Chorioretinopathy

Figure 2

Images from a 21-year-old woman with bilateral FCEs combined with chronic CSC in the right eye (patient 7). The patient presented with micropsia which lasted for one week. (a~j) right eye. (k~t) Left eye. (a, k) Color FPs show round yellowish FCE lesion (right)/reddish FCE lesion (left) in the fovea area. (b, l) MSI 660 nm images show well-defined dark fusiform FCE lesion (b, right)/grayish FCE lesion with blurred margin surrounded by dilated choroidal vessels (l, left). (c, m) Mid-phase FA images show slight window defect in FCE lesions in both eyes. (d, n) Mid-phase ICGA images show hypofluorescent FCE lesions in both eyes (surrounded by dilated choroidal vessels in the left eye), similar to MSI images. (e, o) FAF images show small hypoautofluorescence lesions in both eyes. (f, p) FCE converts from nonconforming to conforming with the resolution of retinal detachment in SD-OCT images in the right eye (f). The morphology of both FCEs does not differ much in the 10-month follow-up duration. Hyperreflective tissues can be seen beneath the FCEs with the obviously thinning choroid in both eyes. (g, h, q, r) FCEs present as the flow signal-absent area surrounded by hyperperfused areas in the default choriocapillaris slab of OCTA (g, q). Images (h, r) show FCEs morphology in the corresponding en face structural OCT. (i, j, s, t) Hyperreflective tissue beneath FCE in B-scan OCT presents as intensive flow signals in the choroid segment of OCTA (i, s) and as a hyperreflective plaque in the corresponding en face structural OCT (j upper, t lower). Dilated choroidal vessels surrounding the FCE can be seen in the left eye (s, t lower). (i, j upper) 63 μm to 91 μm below the RPE reference in the right eye; (s, t lower) 100 μm to 129 μm below the RPE reference in the left eye. (j lower, t upper) B-scan OCT angiogram shows the intensive choroidal flow (in red) beneath the FCE, which is at the same site as the hyperreflective choroidal tissue. The green arrowheads point to the hyperreflective choroidal tissue beneath FCE. The yellow arrowheads point to FCE lesions in all images. The thin white arrows indicate OCT scan direction.