Peripapillary Choroidal Thickening and Cavitation

In the February 2003 issue of the Archives, we described a new funduscopic lesion that we termed peripapillary detachment in pathologic myopia.¹ Clinically, these lesions were seen as a well-circumscribed yellow-orange thickening at the inferior border of the myopic conus. First-generation optical coherence tomographic imaging appeared to show a peripapillary detachment of retinal pigment epithelium and retina. The lesions remained stable during a multiyear follow-up period and did not appear to affect visual function. Further studies, including one in the Archives by Shimada et al,² supported our findings and added that peripapillary detachment in pathologic myopia could surround the entire optic disc and may be associated with abnormalities of retinal vasculature and with visual field defects. With newer-generation optical coherence tomographic imaging, Toranzo et al³ reevaluated these lesions and observed an intrachoroidal hyporeflective space with normal overlying retinal pigment epithelium and retina. This finding was inconsistent with our original description. They suggested a new term for the lesion, peripapillary intrachoroidal cavitation.

We have followed the literature regarding these lesions and agree that our initial interpretation was inaccurate. We have reexamined this entity using enhanced depth imaging spectral-domain optical coherence tomography as described by Spaide et al.⁴ Using this technique, we have noted that the characteristic peripapillary lesions may be associated with choroidal thickening with or without hyporeflective areas of cavitation (Figure 1, Figure 2, and video). We reaffirm the findings of Toranzo and colleagues; however, we propose the term peripapillary choroidal thickening and cavitation to more accurately reflect a spectrum of optical coherence tomographic findings associated with this lesion.

Correspondence: Dr Freund, Vitreous Retina Macula Consultants of New York, 460 Park Ave, Fifth Floor, New York, NY 10022 (kbfnyf@aol.com).

Funding/Support: This work was supported by The Macula Foundation, Inc, New York, New York.