tomography (OCT) of choroidal folds.
GUPTA, MD ROBERT BAHR, MD TIMOTHY YOU, MD
An 85-year-old hyperopic female, with
prior bilateral cataract extraction, was noted on routine dilated fundus examination
to have choroidal folds (Figure 1). A B-scan ultrasound and CT scan of the orbits
revealed no mass. Fluorescein angiography showed typical findings of alternating
light and dark bands in both eyes (Figure 2). Optical coherence tomography of both
fundi demonstrated diffuse wrinkling of the choroid and retinal pigment epithelium
Choroidal folds, although often idiopathic, have been associated with a variety
of syndromes including orbital mass, orbital inflammation, scleritits, scleral buckle,
hypotony, and increased intracranial pressure.1 Furthermore, it has been
hypothesized that these folds also involve the retinal pigment epithelium.2
This case demonstrates the first reported OCT analysis of choroidal folds. The OCT
depicts folding primarily involving the retinal pigment epithelium and the underlying
choroid, but sparing the overlying neurosensory retina. Perhaps, choroidal folds
is a misnomer as these folds are more closely related to folds of the retinal pigment
epithelium layer, as clearly depicted in this OCT.
1. Color fundus photos of (A) right and (B) left eyes. Note the obliquely oriented
striae of alternating light and dark in representing choroidal folds. (Image courtesy
of Gaurav Gupta, MD.)
2. Fluorecein angiography of (A) right and (B) left eyes. The study shows alternating
bands of hyper and hypofluorescent lines. In these late photographs, dye has diffused
into the folds. (Image courtesy of Gaurav Gupta, MD.)
3. Optical coherence tomography of (A) right and (B) left eyes. Both the choroid
and retinal pigment epithelium display areas of wrinkling without affecting the
overlying neurosensory retina. (Image courtesy of Gaurav Gupta, MD.)
Gupta, MD is an ophthalmology resident at Brown Medical School in Providence, RI.
Robert Bahr, MD is assistant clinical professor of ophthalmology at Brown Medical
School in Providence, RI. Timothy You, MD is assistant clinical professor of ophthalmology
at Brown Medical School in Providence, RI. No author has any financial interest
in the information contained in this article. Dr. Gupta can be reached by e-mail
1. Hyvarinen, L. Walsh, FB. Benign Chorioretinal
folds. AJO. 1970;70:14-17.
2. Gass, JD. Radial Chorioretinal Folds.
Arch Ophthalmol. 1981; 99:1016-1018.
Retinal Physician, Issue: July 2005