Peripapillary Intrachoroidal Cavitation in High Myopia: A Case Report

Peripapillary intrachoroidal cavitation (PICC) is an increasingly recognized structural alteration predominantly observed in highly myopic eyes and considered part of the spectrum of myopic posterior segment remodeling. Progressive axial elongation and associated biomechanical stress at the level of the optic nerve head and peripapillary region are thought to contribute to localized choroidal splitting and cavitation formation. The advent of enhanced depth imaging and swept-source optical coherence tomography (SS-OCT) has significantly improved the visualization of the choroid, allowing the precise characterization of PICC as a well-demarcated hyporeflective intrachoroidal space typically located inferior to the optic disc, beneath an intact retinal pigment epithelium-Bruch's membrane complex. We report the case of a highly myopic patient in whom swept-source OCT revealed a peripapillary intrachoroidal cavitation associated with localized choroidal thinning and peripapillary atrophy, without evidence of choroidal neovascularization or subretinal fluid. The diagnosis was established based on multimodal imaging findings. The main differential diagnoses, including pigment epithelial detachment, peripapillary staphyloma, and glaucomatous excavation, were carefully excluded. This case highlights the importance of recognizing the characteristic OCT features of PICC to avoid misdiagnosis and unnecessary therapeutic interventions. A better understanding of its imaging profile and clinical associations is essential, particularly in highly myopic patients in whom structural optic nerve head changes may complicate interpretation. Periodic structural and functional monitoring is recommended given the potential association with visual field abnormalities.