2020–2021 BCSC Basic and Clinical Science Course™
12 Retina and Vitreous
Part II: Disorders of the Retina and Vitreous
Chapter 09: Choroidal Disease
Folds in the choroid, sometimes called chorioretinal folds, occur secondary to several diseases. Forces external to the eye, such as an indenting tumor or thyroid eye disease, can cause folds in the choroid. The sclera may be thickened by posterior scleritis, thereby crowding the choroid. A relatively common cause, one that is also poorly characterized, is the development of choroidal folds in middle-aged adults, some of whom acquire an increased amount of hyperopia. One theory is these patients, who develop bilaterally symmetric horizontal or oblique choroidal folds, may have an inflammatory disease that causes scleral shortening and flattening of the posterior sclera. Engorgement of the choroid causes an expansion of the tissue, which is limited by the sclera. The engorgement can be the result of inflammation and a diffusely infiltrative condition such as lymphoma. Reduced intraocular pressure can cause ciliochoroidal effusions and curvilinear choroidal folds in the posterior pole, a condition known as hypotony maculopathy. Medications such as topiramate can cause idiopathic swelling of the choroid with creation of chorioretinal folds and ciliochoroidal effusions without hypotony. Increased intracranial pressure can cause fine folds that course circumferentially around the optic nerve head; these folds are called Patton lines. Localized choroidal folds can be seen in association with CNV, choroidal neoplasms, and scleral buckles (Fig 9-15).
Spaide RF, Goldbaum M, Wong DW, Tang KC, Iida T. Serous detachment of the retina. Retina. 2003;23(6):820–846.
Figure 9-15 Multimodal imaging of the right eye of a 95-year-old man in whom chorioretinal folds developed after intravitreal anti–vascular endothelial growth factor therapy to treat a fibrovascular pigment epithelial detachment (PED). A, Color and B, red-free photographs show chorioretinal folds (arrows) radiating from the retracted borders of the fibrovascular PED. C, A conventional OCT scan shows little exudation except for a few intraretinal cystic changes. Note the multilamellar hyperreflective structure on the back surface of the partly collapsed PED. D, An EDI-OCT scan shows recurrent fluid exudation (arrowheads) at the base of the fibrovascular PED secondary to choroidal neovascularization on the back surface of the hyperreflective lamellar material.
(Used with permission from Mrejen S, Spaide RF. Optical coherence tomography: imaging of the choroid and beyond. Surv Ophthalmol. 2013;58:387–429.)
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.