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Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.
On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.
A dilated fundus examination was performed demonstrating the following:
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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.
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:
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.
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