Choroidal excavation with polypoidal choroidal vasculopathy: a case report

Wataru Kobayashi,¹ Toshiaki Abe,² Hiroshi Tamai,¹ Toru Nakazawa<sup>1

1</sup>Department of Ophthalmology, ²Division of Clinical Cell Therapy, Center for Advanced Medical Research and Development (ART), Tohoku University Graduate School of Medical Science, Sendai, Japan

Purpose: This is a report of a case of choroidal excavation accompanied by polypoidal choroidal vasculopathy (PCV) and retinal pigment epithelium detachment (PED).
Methods: A 57-year-old Japanese woman who had begun complaining of metamorphopsia in her left eye 7 months earlier underwent spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography (FA), and indocyanine green angiography (IA), as well as a routine ophthalmological examination.
Results: The patient’s intraocular pressure, visual acuity, and visual field were within normal range. Ophthalmoscopy revealed a serous macular detachment, soft drusen, exudates, and a reddish-orange elevated lesion in the macula of the left eye. The right eye was normal. SD-OCT revealed two lesions in the left eye. One was a PED accompanied by a notch sign, and the other was a choroidal excavation. Additionally, FA revealed a window defect in the PED, and IA showed typical PCV. Three monthly injections of antivascular endothelial growth factor preserved visual acuity, but failed to have any visible effect on the lesion during the 6-month follow up period.
Conclusions: This is the first report of choroidal excavation accompanied by PED and PCV. The data suggest that choroidal excavation may be associated with various changes that have not been previously reported. Careful observation of such cases may therefore be necessary.

Keywords: choroidal excavation, polypoidal choroidal vasculopathy, anti-vascular endothelial growth factor treatment