|Year : 2012 | Volume
| Issue : 2 | Page : 126-127
An unusual pattern of idiopathic choroidal folds
Neha Goel1, Vinod Kumar2, Usha K Raina1, Basudeb Ghosh1
1 Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
2 Department of Ophthalmology, University College of Medical Sciences, New Delhi, India
|Date of Web Publication||4-Aug-2012|
9/2, Punjabi Bagh Extension, New Delhi - 110026
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Goel N, Kumar V, Raina UK, Ghosh B. An unusual pattern of idiopathic choroidal folds. Oman J Ophthalmol 2012;5:126-7
Choroidal folds are parallel grooves or striae in the fundus, which may be idiopathic or associated with a variety of conditions. They are seen ophthalmoscopically and on angiography as alternating light and dark streaks oriented horizontally at the posterior pole. Less commonly vertical, oblique, or irregular alignment may be seen.  We describe an unusual pattern of bilateral idiopathic choroidal folds present circumferentially around the posterior pole.
A 50-year-old nonsmoker female presented with the complaint of blurring in her left eye since 3 weeks. She had no significant ocular or medical history.
Her corrected visual acuity was 20/20 in the right eye and 20/30 in the left eye. She had normal anterior segments and pupillary reactions with intraocular pressure of 14 mm Hg in both the eyes. There was no proptosis or restricted ocular movements.
Dilated fundus examination revealed pigmentary changes inferotemporal to the macula in the right eye [Figure 1]a and neurosensory detachment at the macula in the left eye [Figure 1]b. In addition, choroidal folds were noted, present circumferentially around the arcades, in both eyes [Figure 1]a, b. The optic discs were unremarkable. Fluorescein angiography showed a window defect corresponding to the area of pigmentary disturbance in the right eye [Figure 2]a and an inkblot type of leak subfoveally in the left eye [Figure 2]b. The folds were seen prominently owing to their classic alternating hypo and hyperfluorescence [Figure 2]a-c.
|Figure 1: (a) Fundus photograph of the right eye showing subtle choroidal folds temporal to the macula, extending circumferentially from the superior to the inferior vascular arcade and pigmentary changes inferotemporal to the macula (b) Fundus photograph of the right eye showing subtle choroidal folds temporal to the macula, extending circumferentially from the superior to the inferior vascular arcade and neurosensory detachment at the macula|
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|Figure 2: (a) Fluorescein angiography of the right eye showing a window defect corresponding to the area of pigmentary disturbance. The choroidal folds are seen prominently owing to their classic alternating hypo and hyperfluorescence in this unusual configuration (b) Fluorescein angiography of the left eye showing an inkblot type of leak subfoveally. The choroidal folds are seen prominently owing to their classic alternating hypo and hyperfluorescence in this unusual configuration (c) Fluorescein angiography of the left eye showing choroidal folds along the superotemporal arcade|
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Optical coherence tomography revealed a shallow neurosensory detachment in the left eye. B-scan ultrasonography was normal in both eyes, notable for the absence of any mass or flattening of the posterior pole. Axial length measurement by A-scan ultrasonography was 22.56 mm in the right and 22.48 mm in the left eye. Computed tomography (CT) of the orbits showed no evidence of an intraorbital mass or posterior flattening of the globes.
The patient declined a lumbar puncture. She was asked to follow up regularly.
Known causes of choroidal folds include retrobulbar masses, choroidal tumors, scleral diseases, hypotony, papilledema, choroidal neovascularization, or scleral buckle. Though the exact pathogenesis is unknown, it is believed that conditions causing thickening or shortening of the sclera produce wrinkling of Bruch's membrane and the adjacent layers of the choroid and retinal pigment epithelium (RPE). 
When no obvious cause is found, the choroidal folds are considered idiopathic. Increased intracranial pressure can present with only choroidal folds; therefore, these patients should have an appropriate work-up that should probably include a lumbar puncture before being labeled as
Though various patterns and orientations of choroidal folds are described, the circumferential arrangement in the absence of any identifiable cause has not been described. The association of central serous chorioretinopathy (CSR) with idiopathic choroidal folds is known. 
To conclude, the diagnosis of idiopathic choroidal folds is one of exclusion. The mechanism is poorly understood, however, the visual prognosis is good unless the macular area is involved. Management is to observe visual changes and monitor for the development of choroidal neovascularization.
| References|| |
|1.||Albert DM, Jakobiec FA. Choroidal and retinal folds. In: Berson EL, D'Amico DJ, Gragoudas ES, Schepens CL, editors. Principles and practice of ophthalmology. 2nd ed. Philadelphia: WB Saunders; 1994. p. 889-98. |
|2.||Griebel SR, Kosmorsky GS. Choroidal folds associated with increased intracranial pressure. Am J Ophthalmol 2000;129:513-6. |
|3.||Gass JD. Choioretinal folds. In: Gass JD, editor. Stereoscopic atlas of macular disease: Diagnosis and treatment. 4 th ed. St. Louis: Mosby; 1997. p. 288-301. |
[Figure 1], [Figure 2]