A 28-year-old female patient presented with metamorphopsia in her left eye starting 2 days earlier. There was nothing of note in her medical or family history, and her visual acuity was 1.0 in the right eye and 0.8 with -5.0 D refraction in the left eye. Anterior segment examination was normal. Fundus examination was normal in the right eye, but macular pigmentary alterations were observed in the left eye (). On FFA there was hyperfluorescence beginning in the early phases and increasing in the late phase, which was more suggestive of choroidal neovascular membrane (CNVM) than CSCR (). Although it is recommended for a definitive diagnosis, ICGA was not done. Despite smooth foveal contours in the left eye on OCT, an area of subfoveal focal choroidal excavation and overlying hyporeflective subretinal fluid were detected (). The lesion in the patient’s left eye was accepted as CNVM and an intravitreal bevacizumab injection was administered. At follow-up 1 month later, the patient’s symptoms had improved, vision in her left eye improved to 0.9 and the hyporeflective area evident on OCT had decreased in size. At 2-year follow-up, visual acuity in the left eye was 0.8 and persistent RPE changes were observed on fundoscopy (). Hyperfluorescence which increased slightly in the late phases was observed on FFA of the left eye (). On OCT, the focal choroidal excavation remained unchanged, the overlying hyporeflective area had resolved and the photoreceptor layer appeared continuous ().
The chief complaint for this 29-year-old woman was impaired vision in her left eye. At the initial visit for this this patient, a photograph of her left fundus showed white dots (Figure B) with hyperautofluorescence on FAF (Figure D), while OCT revealed a disrupted or irregular photoreceptor inner outer segment (IS/OS) junction (Figure F) indicated by the arrows. At 1 month after her initial visit, this patient complained of metamorphopsia in her right eye. FP showed that there were white dots in the posterior pole (Figure A), while FAF images obtained using FAF revealed hyperfluorescence in the area surrounding the optic disc (Figure C). OCT showed a disrupted or irregular photoreceptor IS/OS junction in both eyes (Figure E and F) indicated by the arrows. At 4 months after her initial visit, there was almost complete improvement of the metamorphopsia in her right and left eyes. In addition, OCT indicated there was ongoing restoration of the IS/OS line in both eyes (Figure A and B). Although the deviation map of ganglion cell analysis showed there was a decrease of the GCL + IPL thickness in both eyes at her initial visit, her right eye was not affected. During the 4 months of follow-up, the deviation map (Figure C~J) did not indicate any recovery of the decreased GCL + IPL thickness. Signal strengths of all the Cirrus OCT measurements were 10/10.