Progressive development of large choroidal excavation in neovascular age-related macular degeneration

Focal choroidal excavation (CE) is an unusual concavity in the choroid without posterior staphyloma or scleral ectasia and with pathogenesis is still unknown. In this article we present a case of de novo progressive focal choroidal excavation associated with exudative age-related macular degeneration (AMD).

This study was designed as a descriptive case report based on clinical and imaging data collected during patient's observation and follow-ups.

A 67-year-old man with systemic hypertension and hypercholesterolemia, with a previous diagnosis of bilateral AMD complicated by already treated macular neovascularization, underwent our attention to perform follow-up visits. Over the 5-year follow-up, the left eye remained stable, requiring no further treatments and disclosing a BCVA of 0.0 LogMAR. On the contrary, the right eye showed several exudation recurrences, requiring further anti-VEGF injections. Structural OCT detected the progressive development of a focal CE, which gradually enlarged converting into a large CE. Structural OCT examinations reported even growing defects of the Bruch's membrane. Despite the evident progression of the CE, BCVA disclosed stable values over the 5-years follow-up (1.0 LogMAR), with a worsening of metamorphopsia.

Large CE may be a complication of neovascular AMD. Bruch's membrane abnormalities, including thickness and reflectivity changes, detectable on structural OCT, can be considered early biomarkers of potentially developing CE.