A novel case description of an isolated unilateral submacular choroidal varix simulating chorioretinal folds and inducing metamorphopsia in a 74-year-old phakic Caucasian man. Posterior segment examination revealed focal choroidal elevations corresponding to a deep, large choroidal vessel in the inferotemporal subparafoveal region. Fundus photography demonstrated a pigment epithelial detachment-like elevation inferior to the fovea, continuous with the course of a large choroidal vessel. Angiographic, indocyanine green (ICG), and spectral-domain optical coherence tomography (SD-OCT) imaging revealed an isolated unilateral submacular choroidal varix with direct connection to an inferior vortex vein. The diagnosis of submacular choroidal varix should be considered when the presence of metamorphopsia and corresponding choroidal elevations that remain unchanged through gaze direction or contact lens ophthalmoscopy occur. If present, angiographic, ICG, and SD-OCT imaging are recommended for proper evaluation of submacular choroidal varix that may enhance the characteristics of this lesion.
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