The authors report the case of a 55-year-old man complaining of metamorphopsia in his left eye (LE). Corrected distance visual acuity (CDVA) was 20/20 in the right eye (RE) and 20/25 in the LE.

Fundoscopy revealed a macular hemorrhage in his LE. Spectral-Domain optical coherence tomography (SD-OCT) showed a bilateral thickened choroid and a retinal pigment epithelium detachment (PED) with submacular hemorrhage in his LE. Fluorescein angiography and indocyanine green angiography showed a focal hyperfluorescent spot suggestive of idiopathic polypoidal choroidal vasculopathy or chronic central serous retinopathy (CCSR) with occult neovascularization.

The patient was submitted to two intravitreal rabinizumab injections without improvement of the PED and so intravitreal aflibercept was attempted.

CDVA of the LE improved to 20/20 and there was a partial resolution of the PED. After 3-months, the RE revealed an extra-foveal neurosensory retinal detachment which was suggestive of CCSR.

Continued vigilance was proposed. Low-fluence photodynamic therapy is to be considered if there is clinical deterioration.