Retina

Case 47

Patient Presentation: A 55-year-old male was referred to a tertiary retina clinic by his optometrist for suspicion of dry age-related macular degeneration (AMD) OS. The patient denied any acute change in vision or family history of AMD. Past medical history included hypothyroidism managed with levothyroxine. 
Vision was 20/20 OU with no RAPD and IOP within normal limits. Slit lamp examination was unremarkable. Near-infrared reflectance imaging was conducted which demonstrated hyper-reflective foci at the macula surrounding a circular focal area of hypo-reflectance at the fovea OS. Multi-color SLO imaging was conducted which demonstrated multiple red foci surrounding the fovea OS suggestive of depigmentation. Right eye imaging was unremarkable. 

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Question: What finding is not appreciated in the OS OCT macula above? 

Question: Based on the initial OCT macula imaging findings, what disease spectrum is high on your differential diagnosis?

An OCT angiography OS was completed to better characterize the hyper-reflectivity at the level of the RPE:

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Question: Based on the OCT-angiography, what entity of PDS is the diagnosis most likely?

Question: What is the mainstay of treatment for pachychoroid neovasculopathy?

Learning Objectives:

1.    The presentation, imaging findings and diagnosis of pachychoroid neovasculopathy.
2.    Characterizing the various entities of pachychoroid disease spectrum.
3.    Treatment of PNV.