Case 45

Patient Presentation: An 80-year-old male was referred to a tertiary retina clinic for assessment of bilateral persistent intraretinal fluid. Patient failed topical treatment for CME and repeated intravitreal anti-VEGF. Past medical history includes T2DM, hypertension, dyslipidemia and coronary artery disease.

Vision was 20/40 OD and 20/30 OS with no RAPD and IOP within normal limits. Slit lamp examination was unremarkable. Dilated fundus examination demonstrated stable intraretinal fluid temporal to the optic disc respecting the macula OU, as well as scattered hard exudates at the macula. Optos wide field fundus photos and OCT maculas are shown below.

Question: What findings are not appreciated on the OCT maculas above?

Question: Based on the location of the intraretinal fluid, which imaging modality and location would be most beneficial?

OCT 5-line rasters of the peripapillary areas OU were completed and shown below:

Question: Based on the findings on OCT macula and peripapillary regions, what is the most likely diagnosis?

Question: What treatment would be indicated for this patient?

Learning Objectives:

1.    The presentation, imaging findings and diagnosis of peripapillary pachychoroid syndrome.
2.    Differentiating PPS from cystoid macula edema and diabetic macular edema.
3.    Treatment of PPS.

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