Abstract
A 43-year-old woman was referred for evaluation of a pigmented fundal lesion in her left eye. Her visual acuity was 20/40. Examination revealed a flat, pigmented lesion at the level of the retinal pigment epithelium (RPE) with lacunae, which involved the inferonasal parafoveal and perifoveal macular areas (Fig A). Diagnosis was consistent with central congenital hypertrophy of the RPE. OCT revealed a conforming choroidal excavation spanning the whole lesion, thickened irregular RPE and outer retinal atrophy in the excavated area, transmission hyper-reflectivity corresponding to lacuna, localized subretinal fluid at foveal edge of excavation, and perifoveal posterior vitreous detachment (Fig B) (Magnified version of Fig A-B is available online at www.aaojournal.org).
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