Chronic CSC with RPE epitheliopathy
35 y male with bilateral progressive diminution of vision, no systemic diseases, anterior segment is clinically free. This case is typical presentation of "Chronic CSC with RPE epitheliopathy" or what is called "Sick RPE syndrome". This is a variant of chronic CSC which has two presentation either : Chronic non resolving CSC or Chronic CSC with RPE epitheliopathy which usually bilateral but assymetrical with multifocal areas of serous detachments, serous RPE detachments or both and later on RPE atrophy or sometimes CNV formation. An important point, serous detachments are difficult to be seen in FFA but it is diagnosed by clinical fundus examination and OCT is the confirming imaging techniques, however RPE detachments could be diagnosed by both FFA (pooling) as in the right eye and of course OCT. And in these cases to diagnose pooling or leakage during FFA you should wait up to 10 min after injection of the dye (recirculation phase). One of the sign of chronic non resolving CSC which is important clue in equivocal cases is the gravitational tract of RPE atrophy seen in the left eye of this patient.