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Case 13


Patient Presentation: A 61-year-old Caucasian man was referred to a uveitis clinic for atypical retinal findings OU. The patient was being treated for neovascular age-related macular degeneration for the previous 2 years. He was initially diagnosed with dry AMD due to peripapillary drusenoid changes, but after 1 year of monitoring, he developed choroidal neovascularization. The referring retinal specialist was concerned for the progression of RPE changes in the peripapillary region. The choroidal neovascularization was quiescent after 4 intravitreal anti-VEGF injections at the time of presentation.

The patient noted decreased vision over the last 6 months with floaters OS > OD. He denied flashes, visual field deficit, and trauma. He denied any past medical or ocular history. Review of systems was negative. His visual acuity was 20/100 OD and CF OS. IOP was within normal limits and there was no RAPD. Fundus photos and fundus autofluorescence images were taken and are shown below:


Question 1: What are the main findings in the fundus photos and fundus autofluorescence images above?

OCT macula images were taken and are shown below:


Question 2: What are the main findings in the OCT macula images above?

Intravenous fluorescein angiography imaging was then conducted. Below is the early and late phase of the right eye, and the late phase of the left eye:  


IVFA imaging demonstrates early hypofluorescence with late hyperfluorescence around the edges of the lesions.

Question 3: Based on the fundus findings, FAF, IVFA, and OCT imaging, what is the most likely diagnosis?

Question 4: What is the most appropriate treatment for this condition?

Learning Objectives:

  1. Understand the typical imaging findings of serpiginous chorioretinopathy

  2. Learn the typical treatment options for serpiginous chorioretinopathy

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