Re: Fung et al.: Focal scleral nodule: a new name for solitary idiopathic choroiditis and unifocal helioid choroiditis (Ophthalmology. 2020;127:1567–1577)

Published:January 06, 2021DOI:https://doi.org/10.1016/j.ophtha.2020.12.007
      We read the article by Fung et al.
      • 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 authors have proposed that this entity should be called a “focal scleral nodule.” Fung et al have previously also suggested that the lesion has a component of scleral collagen based on the hyperautofluorescence of the lesion.
      • Fung A.T.
      • Kaliki S.
      • Shields C.L.
      • et al.
      Solitary idiopathic choroiditis: findings on enhanced depth imaging optical coherence tomography in 10 cases.
      We would like to reiterate comments from a recent article we authored earlier this year entitled, “Solitary idiopathic choroiditis’ or a tumor of scleral origin: A case report based hypothesis.”
      • Kumar P.
      • Chawla R.
      • Balakrishnan J.
      • et al.
      Solitary idiopathic choroiditis' or a tumour of scleral origin: a case report based hypothesis.
      In this article, we suggested that this pathology is more likely to be a nodular mass of scleral origin based on the OCT, intense hyperreflectivity on infra-red imaging, and magnetic resonance imaging of the lesion. In our article, we were reluctant to call this entity a sequelae of posterior scleritis as suggested by Fung et al.
      • Fung A.T.
      • Kaliki S.
      • Shields C.L.
      • et al.
      Solitary idiopathic choroiditis: findings on enhanced depth imaging optical coherence tomography in 10 cases.
      We would like the authors to comment on this based on the current large series that they have published. We congratulate the authors on collating such a large series of cases (63 cases) of this rare entity.
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      References

        • 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
        • 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
        • Kumar P.
        • Chawla R.
        • Balakrishnan J.
        • et al.
        Solitary idiopathic choroiditis' or a tumour of scleral origin: a case report based hypothesis.
        Med Hypotheses. 2020; 139: 109695

      Linked Article

      • Focal Scleral Nodule
        OphthalmologyVol. 127Issue 11
        • In Brief
          To evaluate multimodal imaging findings of solitary idiopathic choroiditis (SIC; also known as unifocal helioid choroiditis) to clarify its origin, anatomic location, and natural course.
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        Ophthalmology
        • In Brief
          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.1 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.2 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).
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