Sir,

Focal choroidal excavation (FCE), is an unusual excavation of the choroid that has been observed on optical coherence tomography (OCT) image.1, 2, 3, 4, 5 Although FCE was previously thought to have a congenital etiology,2 recent evidence suggests that some cases of FCE are acquired.5 To address whether the origin of FCE is congenital or acquired, investigating the presence of FCE in children is necessary because the choroid in children is relatively free from latent pathology that may contribute to the development of acquired FCE. The purpose of the present study was to identify the presence or absence of FCE in children, adolescents, and young adults.

This retrospective study included 1697 eyes from 858 subjects <40 years of age who visited the pediatric ophthalmology or neuro-ophthalmology clinic. To identify FCE, horizontal and vertical spectral domain OCT crosshair scan images centered at the center of the fovea were reviewed. All individual images consisting of a macular volume scan was additionally reviewed.

The mean age was 15.1±11.2 years (range, 3–39 years). A FCE was identified in three eyes (0.18%) of three subjects (0.35%). The first subject (Figure 1a, a 19-year-old male) had a history of unilateral chorioretinitis of unknown origin 10 years before OCT examination. The second subject (Figure 1b, a 26-year-old female) had no history of any intraocular disorder. The third subject (Figure 1c, a 38-year-old male) had a history of blunt ocular trauma 2 years before OCT examination.

Figure 1
figure 1

Infrared images (left column) and OCT images (right column) of the (a) 19-, (b) 26-, and (c) 38-year-old subjects showing a FCE. The white cross on the infrared image and white arrowheads on OCT images indicate the location of the FCE. All three FCEs were the conforming type.

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The major limitation of the present study was that this study was performed with patients visited pediatric ophthalmology and neuro-ophthalmology clinic. Thus, our patients may not accurately represent the general population.

In conclusion, the extremely low prevalence of FCE in this cohort in which the majority of subjects were free from retinal or choroidal disorder, along with the absence of FCE in children and adolescents may suggests that the congenital type of FCE is rare and the majority of FCEs found in adults are likely to be acquired type. A population-based study of young subjects warrants further investigation.