Analysis of Choroidal Folds of the Posterior Pole in Excessive Hyperopia using SD-OCT with Enhanced Depth Imaging (EDI)

Background: Until now the diagnostic possibilities for choroidal folds were limited to conventional methods like ICG angiography and ultrasound and in many cases additional diagnostic tools like MRI and OCT were necessary. With the introduction of high-resolution OCT new modalities of differential diagnostics are possible. Methods: During the last year 3 patients with conspicious funduscopic findings were presented in our office. In 2 patients the changes were observed during the pre-operative examinations before cataract surgery, the third patient had problems with reading in the reading distance. After a complete ophthalmic examination we performed measurements of the choroidal complex using a Spectralis OCT (Heidelberg Engineering) with enhanced depth imaging (EDI) and detected choroidal folds in the area of the temporal vessels without hints for impressing changes from outside. Furthermore we performed a photo documentation. Results: Best corrected visual acuity in patient 1 was at the right eye sph + 8.50 cyl -0.75/25 degrees = 0.6 and at the left eye sph + 9.25 cyl -0.75/170 degrees = 0.5. In patient 2 visual acuity was OD 0.6 and OS 0.5 (OD sph + 8.50 cyl -2.25/10 degrees und OS sph + 7.75 cyl -1.25/175 degrees). The anterior ocular segment was normal besides the cataract, the posterior ocular segment showed parallel choroidal folds in the area of the temporal vessels. The choroid was preserved in full thickness and the folds were parallel in the retina and the choroid, without a distance between the two layers. In patient 3 visual acuity was OD/OS 1.0 with a correction of OD/OS sph + 3.75. The posterior ocular segment showed the same choroidal changes, all the other ocular findings were normal. Conclusion: Using the SD-OCT with enhanced depth resolution the characteristics of idiopathic choroidal folds in excessive hyperopia can be presented. Our observations can be used for the differentialdiagnostic judgement of idiopathic choroidal folds of the posterior pole.