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A 91-year-old Caucasian woman presented at the New England Eye Center at Tufts Medical Center in Boston, Massachusetts in February 2012, with decreased vision in her left eye. She had a history of high blood pressure, thyroid disease and polymyalgia rheumatica. She was pseudophakic and had primary open angle glaucoma. On presentation, she was taking 2 mg of prednisone daily for polymyalgia rheumatica.
On ophthalmic examination, the best-corrected visual acuity (BCVA) was 20/25 in the right eye and 20/60 in the left eye. Dilated fundus examination showed mild retinal pigment epithelium (RPE) changes in the macula in her right eye and subretinal fluid involving the macula in her left eye (figure 1). Fluorescein angiography (FA) showed a well-demarcated area of hyperfluorescence in her left eye with leakage in the late phase (figure 1). Optical coherence tomography (OCT) of the left eye revealed a thickened choroid that could not be accurately measured because the choroidoscleral interface was not visualised. By estimates, it was more than two-times thicker than the age-adjusted normal of 225 μm.1 OCT also showed an exudative retinal detachment consistent with the diagnosis of central serous chorioretinopathy (CSCR) (figure 1). The right eye also had a thicker than normal choroid measuring 459 μm from the outer border of the hyper-reflective RPE to the inner aspect of the choroidoscleral interface beneath the fovea, but without exudative retinal detachment, RPE detachment or evidence of age-related macular degeneration (AMD) (figure 1).