Choroidal lymphoma or something else?
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A 54‑year‑old asymptomatic woman with a history of psoriasis and chronic obstructive pulmonary disease (COPD) under treatment with topical and oral corticosteroids was referred for suspicion of choroidal lymphoma in both eyes (OU). On examination, best‑corrected visual acuity was 20/20 in the right eye (OD) and 20/25 in the left eye (OS). The intraocular pressure, extraocular movements, and slit‑lamp examination were normal OU. There was no conjunctival lymphoid infiltration OU. On funduscopic examination, there was a uniform mottled appearance of the choroid OU.

Funduscopically, the patient had diffuse subtle, yellow, mottled spots deep to the retina OU [Fig. 1 a and b], suggesting possible choroidal lymphoma. However, on autofluorescence [Fig. 1 c], there was localized hypo‑ and hyper auto fluorescence OD (arrows) in the temporal macula, suggesting focally damaged retinal pigment epithelium(RPE), not typical for choroidal lymphoma which more often shows generalized RPE alterations. By OCT [Fig. 1 d], subretinal fluid (SRF) and pachychoroid were documented, measuring 310 µm, suggestive of central serous chorioretinopathy. Furthermore, there was no sign of choroidal infiltration with lymphoma as the choroidal vascular pattern was intact and lacking a “seasick” surface undulation.

Central serous chorioretinopathy (CSCR) is a disorder involving choroidal vascular thickening and dilation of choriocapillaris with leakage of fluid under the RPE, producing RPE detachment and fluid accumulation under the retina. Patient was advised to discontinue corticosteroids. For chronic CSCR, oral eplerenone or spironolactone, mineralocorticoid receptor antagonists, or photodynamic therapy can be employed. Bousquet et al. reported a 3‑month visual acuity outcome of 20/37 after eplerenone treatment, significantly improved from 20/66 at baseline, inferring the presumed role of corticosteroids in CSCR pathogenesis.