Intrachoroidal Cavitation

Overview

Intra-choroidal cavitation at the macula has been described as a focal loss of the outer retina and RPE, with the remaining inner retina making direct contact with the sclera resulting in a “pseudo-fovea” appearance.

These lesions are associated with high myopia and often found on or around patchy chorioretinal atrophy.

They are distinguished from focal choroidal excavation by the involvement of both the choroid and sclera with the sclera found to be posteriorly bowed in approximately half of all cases. FCE in contrast affects only the choroid and the scleral remains unaffected.

Peripapillary intrachoroidal cavitation (PICC) presents on OCT as intrachoroidal hyporeflective spaces with normal retina and RPE overlying it. Half of all cases show an orange-yellow lesion on fundus photography.

The Beijing eye study (2013) found PICC were typically associated with highly tilted optic discs and the presence of a posterior staphyloma.

They may cause glaucoma-like visual field defects.

Case Examples

  • Case 1: Macular intrachoroidal cavitation

    A 56 year old Asian female with high myoipa (-6.00DS) and best corrected visual acuity of 6/7.5 in the right eye.

    Fundus photo and red-free image (right eye)

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    Fundus photo and red-free image (right eye)

    Retinal examination shows an excavated yellow lesion with associated pigmentation inferior to the right fovea and associated RNFL wedge defect.

    Fundus autoflourescence image (right eye)

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    Fundus autoflourescence image (right eye)

    The area of intrachoroidal cavitation appears hypo-fluorescent on FAF.

    OCT line scans - foveal scan (1) and scan through the intrachoroidal cavitation

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    OCT line scans - foveal scan (1) and scan through the intrachoroidal cavitation

    An OCT line scan through the right fovea (1) shows a small cystic space beneath the foveal reflex but the macular architecture is relatively intact otherwise, explaining the relatively good visual acuity. An inferior scan, taken through the intrachoroidal cavitation shows a complete loss of overlying retinal layers and thinning of the choroid with hypertransmission through to the sclera. Th sclera is posteriorly bowed and cavities are visible within the choroid.

  • Case 2: Peripapillary intrachoroidal cavitation

    A 54 year old Asian female with high myopia (-6.25/-0.75 x 180) in the right eye and moderate myopia (-4.00DS) in the left eye. her best corrected visual acuity is 6/6 (20/20) in each eye.

    This patient has been followed at CFEH for 6 years with no progression of either the structural or functional defects seen in the imaging. In this case, the peripapillary intrachoroidal cavitation is believed to be causing a glaucomatous-like field defect.

    Fundus photo and red free image (right eye)

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    Fundus photo and red free image (right eye)

    Retinal photos show an orange-yellow lesion inferior to the highly tilted optic disc. On the red-free image there is a loss of the typical striated retinal appearance inferiorly.

    Fundus photo and red free image (left eye)

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    Fundus photo and red free image (left eye)

    Retinal photos show a highly tilted optic disc with a yellow-orange lesion inferiorly. The red-free image shows an inferior loss of the normal RNFL striations.

    Stereoscopic image (right optic disc)

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    Stereoscopic image (right optic disc)

    Please use a stereoviewer or 15 prism dioptres base out to view the image.

    The stereoscopic view allows an appreciation of the tilted nature of the disc. The inferior neuroretinal rim appears very thin and there is extensive peripapillary atrophy.

    Stereoscopic image (left optic disc)

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    Stereoscopic image (left optic disc)

    Please use a stereoviewer or 15 prism dioptres base out to view the image.

    The stereoscopic view allows an appreciation of the tilted nature of the disc. The inferior neuroretinal rim appears very thin and there is extensive peripapillary atrophy.

    Spectralis OCT line scans (right optic disc)

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    Spectralis OCT line scans (right optic disc)

    OCT shows hypo-reflective intrachoroidal cavitations inferior to the disc. There is a possible optic disc pit inferotemporal to the optic disc margin (image 1).

    Spectralis OCT radial line scan (right optic disc)

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    Spectralis OCT radial line scan (right optic disc)

    A radial scan shows a large hypo-reflective intrachoroidal cavitation inferior to the disc.

    Spectralis OCT line scans (left optic disc)

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    Spectralis OCT line scans (left optic disc)

    Similarly, the left optic disc shows hypo-reflective intrachoroidal cavitations inferiorly.

    Cirrus RNFL analysis

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    Cirrus RNFL analysis

    RNFL analysis shows the inferior RNFL to be thinner than the normative database inferiorly in both eyes. although this may due in part to the disc tilt which has caused an atypical arrangement of the RNFL.

    Cirrus ganglion cell analysis

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    Cirrus ganglion cell analysis

    Ganglion cell analysis shows inferior thinning in the right eye.

    24-2 SITA standard

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    24-2 SITA standard

    24-2 visual fields show a superior arcuate defect in the right field and scattered depressions superiorly in the left field.

Differential Diagnosis

Focal Choroidal Excavation (FCE)

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Chorioretinal Coloboma

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Torpedo Macluopathy

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References

Chen, Y., Ma, X. & Hua, R. (2018) Multi-modality imaging findings of huge intrachoroidal cavitation and myopic peripapillary sinkhole. BMC Ophthalmol 18, 24 (2018).

Ohno-Matsui K, Akiba M, Moriyama M, Ishibashi T, Hirakata A, Tokoro T. (2012) Intrachoroidal cavitation in macular area of eyes with pathologic myopia. Am J Ophthalmol. Aug;154(2):382-93.

Ohno-Matsui, K., Shimada, N., Akiba, M., Moriyama, M., Ishibashi, T., & Tokoro, T. (2013). Characteristics of intrachoroidal cavitation located temporal to optic disc in highly myopic eyes. Eye (London, England), 27(5), 630–638.

You QS, Peng XY, Chen CX, Xu L, Jonas JB (2013) Peripapillary Intrachoroidal Cavitations. The Beijing Eye Study. PLOS ONE 8(10): e78743.