Differential Diagnoses
Central Serous Chorioretinopathy (CSCR): This condition affects men more than women. Fundus Autofluorescence (FAF) images of our patient showed classic descending tract in the right eye which is created by the presence of subretinal fluid in CSCR. The FAF image of the left eye showed remarkable pigmentary change around the left optic nerve. Retinal pigment epithelium changes on OCT and FAF suggest a previous episode of CSCR since there is no subretinal fluid present on OCT at the time of imaging.
Acute Macular Neuroretinopathy (AMN): This condition is known to affect women more than men. Subtle pigmentary change noted on color fundus photographs of both right and left eye along with disruption of outer retinal hyperreflective band seen on macular OCT nasal to the fovea is suspicious of AMN. However, AMN is more common in females than males and it does not tend to involve retinal pigment epithelium and inner choroid.
Acute Zonal Occult Outer Retinopathy (AZOOR): It is typically more common in women than men. FAF images in AZOOR demonstrates hypoautofluorescence adjacent to the optic nerve and OCT shows outer retinal atrophy, which were both present in the case of our patient. However, presence of descending tracts makes AZOOR an unlikely differential diagnosis.
Acute Posterior Multifocal Placoid Pigment Epitheliopathy (AMPPE) and Serpiginous Choroiditis: These conditions tend to affect men and women equally with the onset typically occurring in their middle age. Color fundus photograph shows areas of outer retinal pigmentary change near the optic nerve head. However, FAF images in the above two conditions show complete absence of autofluorescence in the area of old lesions. FAF images of our patient did not show complete absence of autofluorescence.