Case 60

Patient Presentation: A 66-year-old male was referred for decreased vision and metamorphopsia OS.  His past ocular history is significant for central serous chorioretinopathy OS that self-resolved fifteen years ago.  His medical history is significant for diabetes mellitus type II, chronic obstructive pulmonary disease, and a past episode of myocardial infarction.  His current medications include metformin, sitagliptin, empagliflozin, rosuvastatin, lisinopril, aspirin and albuterol. He had a 11-year smoking history.  On examination, BCVA is 20/30 OD and 20/60 OS.  There is no RAPD and IOP is stable. The patient’s OCT macula (OS) is shown below:


Question: Please describe the findings on this OCT.


Question: The patient returns several months later, and a repeat OCT macula is performed as shown above.  Which of the following types of focal choroidal excavation does the patient present with?

Question: Which of the following conditions are focal choroidal excavations associated with?

Question: Which of the following are possible treatment strategies for this patient?

Learning Objectives:

1)    To understand the role of OCT as the gold standard technique in diagnosing focal choroidal excavations
2)    To understand focal choroidal excavation associated complications or conditions