Case of the Month | May 2019

Case of the Month
May 30, 2019

The Case

The patient was a 91 year old man without acute visual complaints. He was seen for a second opinion regarding treatment on the left eye, and he sometimes noticed that images seemed slanted when using the right eye. The left eye had an Avastin treatment elsewhere one month ago for wet age-related macular degeneration. He was found on our examination to have a single parafoveal intraretinal hemorrhage in the left eye. He had no complaints with respect to the right eye. The visual acuity was 20/25-2 OD and 20/100 without correction, pin hole 20/50, J1 OS. Both eyes were pseudophakic without posterior capsular opacity. There was a Weiss' ring in the right eye and the left eye was status post vitrectomy. There appeared to be tiny dots on the surface of the right macula. In the left macula, there was a superficial sheen and there was a single parafoveal intraretinal hemorrhage. The fundus photograph and fluorescein angiogram of the right eye were unremarkable. The OCT of each eye and the FA of the left eye are attached. What was the most likely diagnosis? What treatment, if any, would you recommend?

The left eye had a recurrent epiretinal membrane. There was late cystoid edema, but the OCT did not show significant swelling. There was mild surface irregularity. With J1 near vision, it is possible that correction for refractive error would result in significant visual improvement. The cause of the hemorrhage was uncertain. A recent test for diabetes was negative, and there was only mild hypertension with a blood pressure of 138/72. It could have been related to the epiretinal membrane, and isolated retinal hemorrhages of unclear etiology are not rare among senior citizens.

The right eye had superficial dots that likely reflected cells that had not undergone metaplasia into a fibrous sheet of epiretinal membrane. Observation was warranted.

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The left eye had a recurrent epiretinal membrane. There was late cystoid edema, but the OCT did not show significant swelling. There was mild surface irregularity. With J1 near vision, it is possible that correction for refractive error would result in significant visual improvement. The cause of the hemorrhage was uncertain. A recent test for diabetes was negative, and there was only mild hypertension with a blood pressure of 138/72. It could have been related to the epiretinal membrane, and isolated retinal hemorrhages of unclear etiology are not rare among senior citizens.

The right eye had superficial dots that likely reflected cells that had not undergone metaplasia into a fibrous sheet of epiretinal membrane. Observation was warranted.

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