Choroidal neovascularization associated with focal choroidal excavation

Area of Science:

• Ophthalmology
• Retinal Diseases
• Medical Imaging

Background:

• Choroidal neovascularization (CNV) is a leading cause of vision loss.
• Focal choroidal excavation is a less common finding associated with CNV.
• Understanding the interplay between excavation and CNV is crucial for effective management.

Purpose of the Study:

• To characterize the clinical and imaging features of choroidal neovascularization (CNV) associated with focal choroidal excavation.
• To investigate the relationship between excavation characteristics, patient age, and CNV presentation.
• To evaluate the efficacy of anti-vascular endothelial growth factor (anti-VEGF) therapy for these specific lesions.

Main Methods:

• Retrospective analysis of 16 patients (16 eyes) with CNV and focal choroidal excavation.
• Review of medical records and multimodal imaging, including fluorescein angiography (FA) and spectral-domain optical coherence tomography (SD OCT).
• Assessment of CNV types (Type 1 vs. Type 2) and their location relative to the excavation and Bruch membrane.

Main Results:

• CNV was predominantly Type 1 (beneath RPE) in older patients (>50 years) and Type 2 (subretinal) in younger patients (<50 years).
• Type 2 CNV and some Type 1 CNV cases exhibited classic neovascularization on FA, often confined within the choroidal excavation.
• Anti-VEGF injections in 15 patients led to significant visual acuity improvement (20/44 to 20/26) with a mean of 3.7 treatments over 14.5 months.

Conclusions:

• CNV morphology in focal choroidal excavation appears influenced by RPE/Bruch membrane integrity and patient age.
• Neovascularization tends to follow the excavation's boundaries, frequently presenting as classic CNV.
• Anti-VEGF therapy demonstrates high efficacy and low recurrence rates for CNV associated with focal choroidal excavation.