Retinal Assistant Module Blog

Thirty-six years old female phakic optometrist presented to me with reduced vision. Her BCVA is 20/60 in her left eye, while in her right eye, the BCVA is 20/20; fundus examination showed no remarkable findings. On clinical exam, there is subretinal fluid above and adjacent to a yellowish rounded elevation of RPE. OCT shows central subretinal fluid with PED and visible Bruch's membrane featuring double-layered sign, along with elongation of photoreceptor cells and increased the thickness of choroid and dilated of Haller's. OCT cross-section showing CSCR pre and post-treatment with subthreshold microsecond laser Diagnosis:  Acute central serous retinopathy Management The patient was managed with a subthreshold microsecond laser. Discussion Acute CSR can present as central serous retinal detachment, which features a fluid leak due to RPE pump defect, causing reduced RPE pumping function to keep the retina dry along with increased leakage due to choroidal vasculopathy. Treating c...

CSCR is a spectrum of pachychoroid FFA, OCT, and Fundus image can aid in the diagnosis and the follow-up. Fundus image  Chronic CSR appears as granular RPE changes along with subretinal fluid and PED. Fundus image showing granular RPE changes due to chronic CSCR Optical coherence tomography OCT shows central subretinal fluid with PED and visible with granular changes of the RPE, along with elongation of photoreceptor cells and increased the thickness of choroid and dilated of Haller's. OCT cross-section showing chronic CSCR featuring subretinal fluids and RPE granular changes Fluorescein Fundus Angiography FFA shows a granular hyper fluorescence in the early through late-phase along with subretinal dye pooling and under the RPE in late phases. Early FFA phase showing granular hyperfluorescence  Mid FFA phase showing the increased intensity of granular hyperfluorescence  Late phase showing Mid FFA phase showing the increased intensity of granular hyperfluorescence wi...

CSCR is a spectrum of pachychoroid FFA, OCT, and Fundus image can aid in the diagnosis and the follow-up.   Fundus image PED can present in CSR, which appears as the yellowish rounded elevation of RPE beneath or adjacent to subretinal fluid. Fundus image of acute CSCR case Optical Coherence Tomography  OCT shows central subretinal fluid with PED and Bruch’s membrane increased reflectivity featuring double-layered sign, elongation of photoreceptor cells, and increased thickness of choroid and dilated of Haller's forming pachychoroid. OCT cross-section of acute CSCR showing subretinal fluid, PED and pachychoroid Fluorescein Fundus Angiography FFA shows a hyper fluorescence with the smokestack, or hot spot signs can indicate acute CSR, along with subretinal or Sub RPE dye pooling. Early phase FFA showing early hyperfluorescence sub RPE Mid phase FFA showing early ascending hyperfluorescence from the smokestack leak Late phase showing Smokestack leakage with sub RPE and subretinal...

Thirty-year-old female complaining from metamorphopsia vision is 20/25  She reports that she previously had metamorphopsia nine years ago, and an ophthalmologist treated her with anti-VEGF. Fundus image Her fundus photograph shows a retinal scar with an abnormal foveal reflex. Fundus picture of the focal choroidal excavation Optical coherence tomography Her OCT scan shows focal choroidal excavation forming a hyporeflective space and a disrupted ellipsoid zone, which explains the distorted vision. However, the negative cross-section shows normal retinal thickness with no elevation of retinal tissues and focal choroidal excavation with choroidal thickening and dilated vessel diameter in Haller's layer forming pachychoroid. OCT cross-section shows focal choroidal excavation with pachychoroid OCT cross-section (Negative) shows focal choroidal excavation with pachychoroid Fundus fluorescein angiography FFA shows early hyper fluorescence, which increases in later phases in the form of a ...