This 64YO male received prior photodynamic therapy in one of his eyes for idiopathic central serous chorioretinopathy (ICCS) and was subsequently lost to follow-up for 10-15 years. He presented with 20/400 vision bilaterally.
Multimodal imaging shows classic findings for chronic ICSC. Optos color imaging shows macular and peripapillary pigmentary changes with a suggestion of an inferior gutter OS.
Fundus autofluorescence better shows the bilateral pigmentary changes and inferior gutter OS, and fluorescein angiography shows variable chorioretinal staining.
Triton swept-source OCT shows bilateral thickened choroid, dry central cavitation-like changes OD, and marked cystoid macular edema OS.
Photodynamic therapy was performed for the left eye, although we are not certain this will improve his vision, given the chronicity of these findings.
Learning Points:
Macular edema is an uncommon finding with typical ICSC, likely due at least in part to the external limiting membrane acting as a barrier to subretinal fluid migrating into the retina. Eyes with chronic ICSC, however, can develop retinal edema as in this case.
Gutters are commonly seen in pathology with chronic subretinal leakage, including central serous retinopathy, choroidal hemangioma, choroidal nevus, and uveal melanoma. These pigmentary changes are usually best imaged with FAF.
