Department of Ophthalmology, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, Korea.
Retina. 2021 May 1;41(5):987-996. doi: 10.1097/IAE.0000000000002980.
To investigate the choriocapillaris and choroidal characteristics of focal choroidal excavation (FCE) to establish pathomechanisms of the disease.
Thirty eyes with FCE, 26 eyes with pachychoroid neovasculopathy (PNV), and 25 participants without any conditions (control group) were analyzed retrospectively. The thickness of both choriocapillaris equivalent and whole choroid was measured at three different points: under the lesion (excavation or neovascularization), in the normal retina, and in the fovea of fellow eye. Indocyanine green angiographic images were collected to confirm choriocapillaris ischemia and the presence of choroidal inflammation.
In both FCE and PNV, choriocapillaris-equivalent attenuation was observed under the lesion compared with other region of the retina (28.1 ± 11.3 μm vs. 69.4 ± 20.0 μm in FCE; 23.5 ± 9.7 μm vs. 62.3 ± 14.7 μm in PNV; both P < 0.001). We also observed focal thinning of the whole choroid under the lesion (149.7 ± 88.7 μm vs. 296.6 ± 83.2 μm; P < 0.001) in FCE but not in PNV. Pachyvessels distribution on optical coherence tomography and numerous dark areas on indocyanine green angiography implied that choroidal inflammation was related to the FCE occurrence.
Choriocapillaris ischemia was related to both FCE and PNV. The choroidal thinning under the excavation and adjacent pachyvessels observed in FCE suggested that focal inflammation and scarring may contribute to choriocapillaris ischemia and eventual retinal pigment epithelium retraction with dysfunction in the pathomechanism.
研究局灶性脉络膜凹陷（FCE）的脉络膜毛细血管和脉络膜特征，以确定疾病的发病机制。
回顾性分析 30 只 FCE 眼、26 只肥厚脉络膜新生血管病变（PNV）眼和 25 名无任何病变的对照组参与者。在病变下（凹陷或新生血管）、正常视网膜和对侧眼黄斑处测量三个不同位置的脉络膜毛细血管当量和全层脉络膜厚度。收集吲哚菁绿血管造影图像以确认脉络膜毛细血管缺血和脉络膜炎症的存在。
在 FCE 和 PNV 中，病变下的脉络膜毛细血管当量衰减与视网膜其他区域相比（FCE 中为 28.1 ± 11.3 μm 比 69.4 ± 20.0 μm；PNV 中为 23.5 ± 9.7 μm 比 62.3 ± 14.7 μm；均 P < 0.001）。我们还观察到病变下全层脉络膜局灶性变薄（FCE 中为 149.7 ± 88.7 μm 比 296.6 ± 83.2 μm；P < 0.001），但在 PNV 中没有。光学相干断层扫描上的厚脉络膜血管分布和吲哚菁绿血管造影上的大量暗区表明脉络膜炎症与 FCE 的发生有关。
脉络膜毛细血管缺血与 FCE 和 PNV 均有关。FCE 下的凹陷和相邻厚脉络膜下的脉络膜变薄表明局灶性炎症和瘢痕形成可能导致脉络膜毛细血管缺血，最终导致视网膜色素上皮功能障碍和回缩，这可能是发病机制中的一个环节。
