A 66-Year-Old Woman With Central Vision Loss

Ronald C Gentile, MD; Brooke Nesmith, MD


November 02, 2016

Physical Examination and Workup

Figure 1

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On examination, her vision is 20/80 in the right eye and 20/400 in the left eye. Findings on pupil examination are normal, with no relative afferent pupillary defect. Findings on anterior segment slit-lamp examination are unremarkable, except she has mild nuclear sclerotic cataracts in both eyes.

Dilated funduscopic examination of her right eye reveals a pinkish-red elevation in the fovea, located under the retina, and surrounding subretinal hemorrhage (Figure 1). The fovea of the left eye has white subretinal fibrosis, with reactive pigmentation and accentuation of the overlying yellow luteal pigment centrally and subretinal hemorrhage inferiorly (Figure 2). The fundus in both eyes has a spotted orange appearance with pigmentary mottling. The optic discs in both eyes are pink, with peripapillary changes that have jagged gray lines radiating from them located deep to the retina.

Figure 3

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Fluorescein angiography demonstrates increased hyperfluorescence, with leakage in the macula of the right eye (Figure 3), late staining of the subretinal fibrosis in the left eye (Figure 4), and blockage of fluorescence from the subretinal hemorrhages in both eyes. Spotted areas of increased and decreased fluorescence are observed outside and surrounding the fovea in both eyes. Hyperfluorescence accentuation of the peripapillary linear streaks is noted in both eyes.

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Figure 6

Optical CT scanning of the macula in the right eye reveals elevation of the retinal pigment epithelium (RPE), with overlying and adjacent separation of the neurosensory retina and disruption of the photoreceptor layer (Figure 5). Optical CT of the macula in the left eye reveals elevation of the hyper-reflective subretinal fibrosis, total loss of the overlying photoreceptor layer, cystic changes, and edema of the overlying neurosensory retina (Figure 6).


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