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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 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?

A. Vitreous inflammation

B. Intra-retinal cysts

C. Epiretinal membrane

D. Subretinal fluid

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

A. Central Serous Chorioretinopathy

B. Cystoid Macular Edema

C. Vitreomacular traction

D. Solar maculopathy

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

A. Ketoconazole

B. Intravitreal Anti-VEGF

D. Mineralocorticoid receptor antagonists

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?

A. Retinoschisis

B. Choroidal neovascular membrane

C. CSCR recurrence

D. Lamellar hole

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

A. Systemic steroids

B. Oral antibiotics

C. Intravitreal Anti-VEGF Injections

D. Plasma exchange therapy

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:

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

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