Asymmetrical Macular Thinning on Optical Coherence Tomography (OCT) in Pigmented Paravenous Retinochoroidal Atrophy

Pigmented paravenous retinochoroidal atrophy (PPRCA) is a rare, typically non-progressive retinal disorder characterized by perivenous atrophy of the retinal pigment epithelium and choriocapillaris, with macular involvement being uncommon. This report aims to highlight a novel manifestation of asymmetrical macular thinning in PPRCA. A 40-year-old man presented with bilateral, gradual visual decline. Fundus examination revealed perivenous retinochoroidal atrophy with pigmentation along the arcades in both eyes and notable macular changes. Spectral-domain optical coherence tomography (OCT) demonstrated bilateral central retinal thinning, most marked in the temporal parafovea, with attenuation of both inner and outer retinal layers and preservation of the foveal depression. Fundus autofluorescence showed corresponding areas of hypoautofluorescence, while systemic evaluation excluded infectious and inflammatory causes. This case, to our knowledge, represents the first description of asymmetrical macular thinning in PPRCA, broadening the recognized spectrum of its macular involvement and emphasizing the diagnostic value of OCT in differentiating PPRCA from inflammatory and inherited retinal disorders.