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A 57-year-old Caucasian man presented with a history of visual disturbance in the right eye and a minimal disturbance in the left eye for the last several months. The patient noted a paracentral scotoma in a jagged pattern with central preservation of vision in the right eye and minimal visual changes in the left. He had a history of hypertension and a Bacillus Calmette-Guérin vaccination with a negative purified protein derivative skin test. A review of his systems and an extensive workup—including tests for syphilis, HIV and toxoplasmosis—was negative. Prior to presentation, the patient had been diagnosed with serpiginous choroidopathy and started on prednisone.
At his most recent exam, the patient’s BCVA was 20/80 in the right eye and 20/20 in the left. The patient was on 40 mg of prednisone daily. The treatment plan was to add cyclosporine and possibly azathioprine in an attempt to taper prednisone. Since the patient was at risk for choroidal neovascularization, close follow-up and regular home Amsler monitoring was recommended.
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