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Case 71

Contributor: Ahmed Abdelaal, CC3

Patient Presentation: A 61-year-old male presented with a 1-month history of painless decrease in vision in his left eye. He had no past medical or ocular history. He denied medication use. On examination, best-corrected distance visual acuity was 20/20 OD and 20/40 OS. IOP was 11 OD and 10 OS, and there was no RAPD. Slit lamp examination was unremarkable. 

An OCT macula of the left eye is shown below:


Question 1: What abnormality is visualized in this patient's OCT?

Question 2: What additional finding is seen on OCT macula OD?

Question 3: What is the most common initial treatment for this condition?

The patient's central serous chorioretinopathy spontaneously resolved three months later, with an improvement to his visual acuity of 20/25 OS. Despite the initial improvement, the patient re-presented to the ophthalmology service 18 months later with worsening of his visual acuity in his left eye, which now measured 20/60 OS. He had a repeat OCT which showed the following:


Question 4: What is the key OCT finding?

Question 5: What is the initial treatment for this patient?

The patient was treated with intravitreal Eylea (anti-VEGF) therapy once a month for 3 months, which led to the resolution of the bleed that was caused by the choroidal neovascular membrane. His vision improved to 20/30 OS.

Learning Objectives:

  1. Recognize the clinical and OCT features of pachychoroid spectrum, including central serous chorioretinopathy and pachychoroid neovasculopathy.

  2. Understand the treatment and management of central serous chorioretinopathy and pachychoroid neovasculopathy. 

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