Article Date: 7/1/2005

A Case Study
Optical coherence tomography (OCT) of choroidal folds.

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 (Figure 3).

COMMENT: 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.

Figure 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.) Figure 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.)
Figure 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.)

Gaurav 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 at gaurav.gupta@umassmed.edu.

 

REFERENCES

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