A 55-year-old man with significant hyperopia presents with chorioretinal folds affecting both eyes. IOPs were within normal limits and anterior segment examinations were unremarkable.
Patients with chorioretinal folds may experience symptoms such as visual distortion (metamorphopsia), decreased clarity of vision, or in some cases, areas of visual field loss. These symptoms often correlate with the extent and anatomical location of the folds. Involvement of the macular region is particularly worrisome, as it may result in more pronounced visual dysfunction. These folds can develop without an identifiable cause or may result from various conditions such as ocular hypotony, marked hyperopia, increased intracranial pressure, choroidal neovascularization, tumors, orbital abnormalities, or inflammatory processes. Typically, chorioretinal folds involve multiple layers of the eye, including the choroid, Bruch’s membrane, retinal pigment epithelium (RPE), and sometimes the overlying neurosensory retina.
Clinically, the folds may be observed as linear, ripple-like striations on the fundus, and comprehensive imaging—such as OCT, fundus photography, and fluorescein or indocyanine green angiography—is crucial for accurate diagnosis and follow-up. On fluorescein angiography, chronic folds exhibit a distinctive horizontal pattern of alternating light and dark bands due to the physical undulations of the retina and associated structures.
Autofluorescence imaging can reveal a similar pattern, though the bands appear inverted. The RPE cells at the crest of a fold, which contain less lipofuscin, appear dark on autofluorescence, while the compressed RPE cells at the base, which have higher lipofuscin content, appear bright.
Optical coherence tomography (OCT) plays a pivotal role in visualizing the morphological changes induced by the folds, particularly the undulating profile of the outer retina and the retinal pigment epithelium.
The therapeutic approach to chorioretinal folds is contingent on addressing the primary cause. For instance, resolution may be achievable if the underlying factor—like ocular hypotony or an orbital mass—is appropriately managed. Nevertheless, if the folds persist over a prolonged period, they can lead to irreversible retinal changes and lasting visual compromise, even if the inciting condition is corrected.
Credit: M. Giray Ersoz, MD, FEBO
Biruni University School of Medicine, Department of Ophthalmology, Istanbul, Turkey
Instagram accounts: @retina.review and @retina.dr.girayersoz
and Sepideh Lotfi, MD
Biruni University School of Medicine, Department of Ophthalmology, Istanbul, Turkey