Reply

Published:January 06, 2021DOI:https://doi.org/10.1016/j.ophtha.2020.12.006
      Reply:
      We thank Chawla and Kumar for their interest in our work, and congratulate the authors for their recent case report in which they used multimodal imaging including swept-source OCT to identify the scleral location of what was then known as solitary idiopathic choroiditis.
      • Kumar P.
      • Chawla R.
      • Balakrishnan J.
      • et al.
      ‘Solitary idiopathic choroiditis’ or a tumour of scleral origin: a case report based hypothesis.
      We first described these lesions as emanating from the sclera rather than the choroid in our 2013 series of 10 cases imaged with enhanced-depth imaging OCT.
      • Fung A.T.
      • Kaliki S.
      • Shields C.L.
      • et al.
      Solitary idiopathic choroiditis: findings on enhanced depth imaging optical coherence tomography in 10 cases.
      It is only more recently, however, that we have accumulated a sufficient number of further cases (n = 63) over an extended period of time (up to 25 years) to feel confident in renaming this entity “focal scleral nodule” (FSN).
      • Fung A.T.
      • Waldstein S.M.
      • Gal-Or O.
      • et al.
      Focal scleral nodule: a new name for solitary idiopathic choroiditis and unifocal helioid choroiditis.
      Despite our improved understanding of FSN,
      • Fung A.T.
      • Waldstein S.M.
      • Gal-Or O.
      • et al.
      Focal scleral nodule: a new name for solitary idiopathic choroiditis and unifocal helioid choroiditis.
      the etiology of these lesions remains unclear. Although we considered the possibility the lesions represented regressed focal posterior scleritis, we did not mention this in our 2013 paper
      • Fung A.T.
      • Kaliki S.
      • Shields C.L.
      • et al.
      Solitary idiopathic choroiditis: findings on enhanced depth imaging optical coherence tomography in 10 cases.
      as Chawla and Kumar suggest. The original descriptions of FSN included cases of inflammatory lesions (references 1 and 2 in the original article), but as we have explained, these studies predated the availability of OCT and likely included a heterogenous collection of pathologies that were not true FSN.
      • Fung A.T.
      • Waldstein S.M.
      • Gal-Or O.
      • et al.
      Focal scleral nodule: a new name for solitary idiopathic choroiditis and unifocal helioid choroiditis.
      In addition, the orange halo seen around 44% of these cases
      • Fung A.T.
      • Waldstein S.M.
      • Gal-Or O.
      • et al.
      Focal scleral nodule: a new name for solitary idiopathic choroiditis and unifocal helioid choroiditis.
      may have been mistaken for inflammation without the benefit of current imaging modalities. In our recent series, the FSNs did not demonstrate any active inflammation on fundus imaging and no underlying infective or inflammatory associations were identified on systemic investigation.
      • Fung A.T.
      • Waldstein S.M.
      • Gal-Or O.
      • et al.
      Focal scleral nodule: a new name for solitary idiopathic choroiditis and unifocal helioid choroiditis.
      Until histopathologic evidence is forthcoming, the etiology of FSN will likely remain elusive.

      References

        • Kumar P.
        • Chawla R.
        • Balakrishnan J.
        • et al.
        ‘Solitary idiopathic choroiditis’ or a tumour of scleral origin: a case report based hypothesis.
        Medical Hypotheses. 2020; 139: 109695
        • Fung A.T.
        • Kaliki S.
        • Shields C.L.
        • et al.
        Solitary idiopathic choroiditis: findings on enhanced depth imaging optical coherence tomography in 10 cases.
        Ophthalmology. 2013; 120: 852-858
        • Fung A.T.
        • Waldstein S.M.
        • Gal-Or O.
        • et al.
        Focal scleral nodule: a new name for solitary idiopathic choroiditis and unifocal helioid choroiditis.
        Ophthalmology. 2020; 127: 1567-1577

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