Purpose: To describe the role of multimodal imaging in a case of coexisting pachychoroid diseases.
Case description: We report a case of a 43 year old lady with coexistent central serous chorioretinopathy (CSC) and pachychoroid neovasculopathy (PNV) in the same eye which posed a diagnostic challenge. Fundus examination showed neurosensory detachment (NSD) at the macula along with retinal pigment epithelial alterations. Optical coherence tomography (OCT) showed a shallow pigment epithelial detachment and OCT angiography showed the presence of vascular network in outer retina choriocapillaris slab suggesting a diagnosis of PNV. However, fundus fluorescein angiography (FFA) showed a smoke stack leak adjacent to the site of vascular network. Focal laser photocoagulation of the leaky point resulted in resolution of NSD pointing towards a diagnosis of CSC.
Conclusion: This case emphasises the role of multimodal imaging in identifying the source of leak in coexistent pachychoroid spectrum diseases.
Keywords: Pachychoroid neovasculopathy; central serous chorioretinopathy; fluorescein angiography; focal laser photocoagulation.