Purpose To investigate morphological changes of focal choroidal excavation (FCE). Methods The medical records of 18 FCE patients (25 eyes) were retrospectively reviewed. Clinical features as well as images of ocular fundus, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and spectral domain optical coherence tomography (OCT) were analyzed. OCT images were employed as a major criterion to evaluate the changes which occurred during the follow-up. Result Of the 18 patients, 9 were male and 9 were female. The mean age was 41 +/- 13.5 years. The follow-up period was 38.5 +/- 24.7 (7-92) months. Thirteen patients were myopic. FCE appeared from slight pigment irregularity to yellowish white plaque. FFA revealed window defects corresponding to the lesions. Early-phase ICGA images showed hypofluorescence and medium to large choroidal blood vessels. Plaque- or dot-like hyperfluorescence was seen on late-phase images. OCT scans showed that 11 patients had unilateral FCE and 7 patients were bilaterally affected. Twenty-three eyes had a single FCE and the other two eyes had 2 excavations. FCE presented as confirming type in 21 eyes and non-confirming type in 3 eyes. Discontinuity of the interdigitation zone, ellipsoid zone, and retinal pigment epithelium/Bruch's complex zone was found. The average subfoveal choroidal thickness was 312.06 +/- 66.12 mu m in FCE eyes. During the follow-up, choroidal neovascularization developed in 4 patients and retinal pigment epithelium discontinuity was aggravated in one eye. No remarkable changes were found in the other eyes on B scan of the OCT images, but the volume of FCE might have changed a little. Conclusion FCE, both confirming type and non-confirming type, may keep stable during a long period of time. Choroidal neovascularization may develop at the site of FCE.