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Case 72

Contributor: Charbel Wahab

Patient Presentation: A 54-year old male with no past ocular or medical history presented to clinic with 2-week history of painless decrease in vision of the right eye. Visual acuity was 20/40 OD and 20/20 OS. Pupils were equal and reactive, with no relative afferent pupillary defect. Slit lamp examination was unremarkable. 

An OCT of the right eye was conducted and is shown below:


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

Question 2: What is the current diagnosis?

The patient's CSCR spontaneously resolved one month after observation with VA improving to 20/20. The patient was stable with VA of 20/20 at five-month follow-up. One year after his CSCR diagnosis, the patient presented with metamorphopsia and reduced VA of 20/20-2 in the right eye. An OCT of the right eye was conducted and is shown below:


Question 3: What are the abnormalities seen on this OCT?

Question 4: What is the diagnosis?

The patient was immediately started on intravitreal anti-vascular endothelial growth factor (VEGF) injection treatment with resolution of the subretinal fluid and hemorrhage. He was followed regularly with serial imaging for three years. OCT images of the right eye after three years since starting anti-VEGF therapy is shown below: A: at 16 months; B: at 21 months; C: at 29 months; D: at 37 months


Question 5: What is the diagnosis?

Learning Objectives:

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

  2. Identify and diagnose all types of focal choroidal excavation.

  3. Recognize the etiologies of focal choroidal excavation as congenital and acquired and its association with pachychoroid spectrum.

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