Bilateral Chronic Central Serous Chorioretinopathy Leads to Macular Atrophy: A Case Report.

We report a rare case of progressive bilateral atrophic maculopathy in the setting of a pachychoroid, secondary to chronic and complicated central serous chorioretinopathy (CSCR). A 58-year-old man reported progressive bilateral visual acuity loss and a central scotoma in the left eye, with a background of longstanding contralateral CSCR. Clinical examination and multimodal imaging (optical coherence tomography (OCT) and fluorescein angiography) confirmed subretinal fluid (SRF) in OD with atrophic maculopathy within the pachychoroid spectrum, without any indirect signs of active neovascularization. Treatment with oral acetazolamide and a topical anti-inflammatory agent was initiated, and the patient was closely monitored. During follow-up, visual acuity improved in the right eye, with a reduction in SRF, while these remained stable in the left eye. This case is notable for its asymmetric bilateral presentation, with unilateral atrophy and persistent contralateral subretinal serous detachment, a pattern rarely described in chronic CSCR. It also highlights that in cases where therapeutic options are limited, acetazolamide and anti-inflammatory drops can help reduce SRF and increase visual acuity. The development of new pseudodrusen and the absence of active exudation, despite advanced involvement, further underscore the atypical nature of this presentation.