to report a case of choroidal excavation accompanied by vogt - koyanagi - harada disease ( vkh ) .
a 54-year - old japanese woman who was complaining of bilateral blurring of vision associated with headache underwent optical coherence tomography ( oct ) , fluorescein angiography , and indocyanine green angiography as well as a routine ophthalmological examination .
oct of the left eye revealed the presence of a unilateral choroidal excavation under the fovea and subretinal fibrin over the site of the excavation .
treatment successfully resolved vkh symptoms with gradual resolution of subretinal fibrin and fluid ; however , the choroidal excavation remained .
our results suggest that choroidal excavation can be induced by choroidal inflammation caused by vkh .
due to the increased availability of optical coherence tomography ( oct ) imaging , the entity of focal choroidal excavation has gained interest in recent years .
it has been well - described in healthy individuals with otherwise normal eyes [ 1 , 2 , 3 , 4 ] .
focal choroidal excavation has been defined as an area of choroidal excavation in the macular area detected with oct without the existence of a posterior staphyloma or scleral ectasia .
we report a case of unilateral choroidal excavation in a patient with vogt - koyanagi - harada disease ( vkh ) .
a 54-year - old japanese woman presented with bilateral blurring of vision associated with headache that had started 2 weeks earlier .
her general family medical history and her personal medical history , including her history of ocular disease , were unremarkable .
the best - corrected visual acuity on presentation was 0.6 in the right eye and 0.1 in the left eye .
slit - lamp biomicroscopy showed bilateral anterior chamber cells and posterior synechiae , and fundus examination showed bilateral disc swelling with exudative retinal detachment ( fig .
fluorescein angiography detected bilateral multifocal leakage with pooling of dye in the subretinal space in the late phase ( fig .
1d ) . a spectral - domain oct ( cirrus hd - oct 4000 ; carl zeiss meditec inc . )
image of the eyes showed the bilateral presence of subretinal fluid and pigment epithelial detachment .
moreover , only in the left eye was unilateral choroidal excavation detected under the fovea , and the contour of the retinal pigment epithelium appeared to be conforming to the shape of the fibrin ( fig .
thus , our patient was treated with intravenous pulse methylprednisolone followed by oral prednisolone ( initial dose of 40 mg / day ) with tapering over a course of 6 months .
treatment successfully resolved the vkh symptoms , and serial oct showed a gradual reduction in size and a subsequent disappearance of the subretinal fibrin and fluid ( fig .
d ) . however , 1 month after having started treatment , the eye was left with an area of choroidal excavation at the fovea despite a normal contour in the right eye ( fig .
2d ) . there was a good recovery of visual acuity , with 1.2 and 0.9 in the right and the left eye , respectively .
since then , many reports have been published , discussing the association between choroidal excavation and central serous chorioretinopathy [ 2 , 3 , 4 ] .
however , the current case of choroidal excavation associated with vkh is the first report in which a preexisting choroidal inflammation caused these conditions . concerning the pathogenesis of choroidal excavation in our case
, it has been speculated that subretinal fibrin might exert a direct pressure effect on the choroidal layer by disrupting its integrity .
our case suggests one of the possible mechanisms of developing choroidal excavation as a result of ocular inflammation .
it is likely that the inflammation induced focal choroidal atrophy , and thinning could also contribute to the development of the choroidal excavation .
a further study should be warranted to elucidate the clinical course and possible mechanism of choroidal excavation associated with vkh . in conclusion
the pathogenesis of choroidal excavation still remains to be addressed ; however , the current case highlights the fact that choroidal excavation can be induced by choroidal inflammation caused by vkh .
the authors have no proprietary or commercial interest in any of the material discussed in this article .
 purposeto report a case of choroidal excavation accompanied by vogt - koyanagi - harada disease ( vkh).methodsa 54-year - old japanese woman who was complaining of bilateral blurring of vision associated with headache underwent optical coherence tomography ( oct ) , fluorescein angiography , and indocyanine green angiography as well as a routine ophthalmological examination.resultsfundoscopy showed papilloedema and serous retinal detachment in both eyes . 
 fluorescein angiography detected bilateral multifocal leakage with pooling of dye in the subretinal space . 
 indocyanine green angiography showed patches of hyperfluorescence and hypofluorescent spots bilaterally . 
 a diagnosis of vkh was reached soon afterwards . 
 oct of the left eye revealed the presence of a unilateral choroidal excavation under the fovea and subretinal fibrin over the site of the excavation . 
 treatment successfully resolved vkh symptoms with gradual resolution of subretinal fibrin and fluid ; however , the choroidal excavation remained.conclusionsthis case is the first report of choroidal excavation associated with vkh . 
 our results suggest that choroidal excavation can be induced by choroidal inflammation caused by vkh . 
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