A CASE OF RELAPSING RETINAL PIGMENT EPITHELIAL DETACHMENT IN PERIPAPILLARY PACHYCHOROID PIGMENT EPITHELIOPATHY

PURPOSE: To report the findings in a patient with peripapillary pachychoroid pigment epitheliopathy who demonstrated a retinal pigment epithelial detachment (PED) that was present at some times but not other times. METHODS: A review of 24 months of the clinical course and findings on multimodal imaging, including color fundus photography, fundus autofluorescence, spectral domain optical coherence tomography, and enhanced depth imaging optical coherence tomography. Choroidal thickness was measured by exporting the optical coherence tomography images to ImageJ (National Institutes of Health) for analysis. RESULTS: A 75-year-old Asian woman complaining of metamorphopsia had a relapsing PED but no intraretinal or subretinal fluid. Multimodal imaging demonstrated an orange-reddish appearance and hyperautofluorescence/hypoautofluorescence in the nasal macula, chronically thickened choroid located beneath the PED and peripapillary region, and variability in the presence of Sattler layer of the choroid, with its disappearance in the foveal region during exacerbation of the condition, and its emergence when the PED resolved. CONCLUSION: In pachychoroid pigment epitheliopathy, PED can develop and spontaneously resolve, and variations in choroidal thickness and the presence of Sattler layer may be an indicator of changes in disease activity.