Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.

On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.

A dilated fundus examination was performed demonstrating the following:

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Retina

Case 37

Patient Presentation: A 46-year-old asymptomatic male is referred for evaluation of a retinal pigmented lesion. BCVA was 20/20 OU, no RAPD was detected, and visual fields were preserved. Fundus photograph and OCT OS were performed and are shown below.

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Question: What is the most likely diagnosis?

A. Choroidal nevus

B. Posterior uveitis

C. Age-related macular degeneration (AMD)

D. Choroidal melanoma

Question: What is the main abnormality seen on the OCT?

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A. Choroidal shadowing

B. Hyper-reflectivity beneath the RPE

C. Thinning of the choriocapillaris

D. Ruptured Bruch’s membrane

F. A, B, C, and D

Question: What is the most reasonable management plan for the patient?

A. Intravitreal anti-VEGF

B. No follow up required

C. Intraocular corticosteroids

D. Routine follow-up with or without fundus photo and OCT

Learning Objectives:

1. To diagnose and recognize choroidal nevus on OCT

2. To appreciate predictive factors for choroidal nevus transformation into choroidal melanoma