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87-year-old woman I saw in the office on February 8, 2008. She has had age-related macular degeneration in both eyes for some time with disciform scars. She takes a baby aspirin about every other day. She has noticed over the last month or two decreased vision in her left eye. She also has had borderline glaucoma for some time. VISUAL ACUITY: OD: 20/200, OS 20/400. IOP: OU 19. SLIT LAMP EXAM: The posterior chamber lens is in good position in both eyes. The left eye has no rubeosis. GONIOSCOPY: Gonioscopy of the left eye shows the angles to be clear of rubeosis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.3. There is an atrophic macular scar 3 disc diameters across. OS: Vertical C/D ratio is 0.1. There is 3+ optic nerve edema. There is a posterior vitreous separation. There is an atrophic macular scar 3 disc diameters across. There is also dilated retinal veins in all four quadrants with retinal hemorrhage in all four quadrants. OCT SCAN: The OCT scan of the right eye shows retinal atrophy. The left eye shows retinal atrophy with macular edema predominately nasal to the fovea. FLUORESCEIN ANGIOGRAM: FA of the left eye shows poor circulation with the re-circulation time of almost 20 seconds, which normal being less than 4 seconds. In the left eye there is also late leakage from the macular vessels. The perfusion in the periphery looks pretty good. I do not see greater than 10 areas of non-perfusion. The right eye has hyperfluorescence corresponding to the macular scar. IMPRESSION: 1. AGE-RELATED MACULAR DEGENERATION – BOTH EYES 2. CHRONIC MACULAR SCARS – BOTH EYES 3. NEW CENTRAL RETINAL VEIN OCCLUSION WITH MACULAR EDEMA AND OPTIC NERVE EDEMA – LEFT EYE DISCUSSION: I explained to the patient that unfortunately her left eye now in addition to her macular degeneration has a central retinal vein occlusion. Treatments at this moment for central retinal vein occlusions are not very good. Injectible Avastin and Lucentis will sometimes dry up the macula, but in the long term, the visual responses are often disappointing. Intravitreal Kenalog we will sometimes consider, but in patients who have possible glaucoma, the risk of the treatment may not be worth the potential benefits. There are some patients with central retinal vein occlusion who will improve on their own and I suggested we watch her closely and see which way the eye goes prior to instituting any sort of therapy. I asked her to return for a check in one month, sooner should she notice any problems. She will see you back periodically. I warned her there is a small possibility of neovascular glaucoma and should her eyes start to hurt and her vision decline and the eye become red, she should come back for urgent evaluation.

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Central Retinal Vein Occlusion - New- and old Macular Scar from AMD144 views87-year-old woman with longstaning macular scars and new vision loss left eye for 2 months. OD: 20/200, OS 20/400. 00000
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Central Retinal Vein Occlusion - New- and old Macular Scar from AMD114 views87-year-old woman with longstaning macular scars and new vision loss left eye for 2 months. OD: 20/200, OS 20/400. 00000
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Central Retinal Vein Occlusion - New- and old Macular Scar from AMD72 views87-year-old woman with longstaning macular scars and new vision loss left eye for 2 months. OD: 20/200, OS 20/400. 00000
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Central Retinal Vein Occlusion - New- and old Macular Scar from AMD74 views87-year-old woman with longstaning macular scars and new vision loss left eye for 2 months. OD: 20/200, OS 20/400. 00000
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Central Retinal Vein Occlusion - New- and old Macular Scar from AMD72 views87-year-old woman with longstaning macular scars and new vision loss left eye for 2 months. OD: 20/200, OS 20/400. 00000
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Central Retinal Vein Occlusion - New- and old Macular Scar from AMD60 views87-year-old woman with longstaning macular scars and new vision loss left eye for 2 months. OD: 20/200, OS 20/400. 00000
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Central Retinal Vein Occlusion - New- and old Macular Scar from AMD63 views87-year-old woman with longstaning macular scars and new vision loss left eye for 2 months. OD: 20/200, OS 20/400. 00000
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Central Retinal Vein Occlusion - New- and old Macular Scar from AMD73 views87-year-old woman with longstaning macular scars and new vision loss left eye for 2 months. OD: 20/200, OS 20/400. 00000
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Central Retinal Vein Occlusion - New- and old Macular Scar from AMD51 views87-year-old woman with longstaning macular scars and new vision loss left eye for 2 months. OD: 20/200, OS 20/400. 00000
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Central Retinal Vein Occlusion - New- and old Macular Scar from AMD47 views87-year-old woman with longstaning macular scars and new vision loss left eye for 2 months. OD: 20/200, OS 20/400. 00000
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Central Retinal Vein Occlusion - New- and old Macular Scar from AMD69 views87-year-old woman with longstaning macular scars and new vision loss left eye for 2 months. OD: 20/200, OS 20/400. 00000
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Central Retinal Vein Occlusion - New- and old Macular Scar from AMD41 views87-year-old woman with longstaning macular scars and new vision loss left eye for 2 months. OD: 20/200, OS 20/400. 00000
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Central Retinal Vein Occlusion - New- and old Macular Scar from AMD51 views87-year-old woman with longstaning macular scars and new vision loss left eye for 2 months. OD: 20/200, OS 20/400. 00000
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Central Retinal Vein Occlusion - New- and old Macular Scar from AMD64 views87-year-old woman with longstaning macular scars and new vision loss left eye for 2 months. OD: 20/200, OS 20/400. 00000
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Central Retinal Vein Occlusion - New- and old Macular Scar from AMD42 views87-year-old woman with longstaning macular scars and new vision loss left eye for 2 months. OD: 20/200, OS 20/400. 00000
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Central Retinal Vein Occlusion - New- and old Macular Scar from AMD65 views87-year-old woman with longstaning macular scars and new vision loss left eye for 2 months. OD: 20/200, OS 20/400. 00000
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Central Retinal Vein Occlusion - New- and old Macular Scar from AMD78 views87-year-old woman with longstaning macular scars and new vision loss left eye for 2 months. OD: 20/200, OS 20/400. 00000
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Central Retinal Vein Occlusion - New- and old Macular Scar from AMD78 views87-year-old woman with longstaning macular scars and new vision loss left eye for 2 months. OD: 20/200, OS 20/400. 00000
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Central Retinal Vein Occlusion - New- and old Macular Scar from AMD106 views87-year-old woman with longstaning macular scars and new vision loss left eye for 2 months. OD: 20/200, OS 20/400. 00000
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87-year-old woman I saw in the office on February 8, 2008. She has had age-related macular degeneration in both eyes for some time with disciform scars. She takes a baby aspirin about every other day. She has noticed over the last month or two decreased vision in her left eye. She also has had borderline glaucoma for some time. VISUAL ACUITY: OD: 20/200, OS 20/400. IOP: OU 19. SLIT LAMP EXAM: The posterior chamber lens is in good position in both eyes. The left eye has no rubeosis. GONIOSCOPY: Gonioscopy of the left eye shows the angles to be clear of rubeosis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.3. There is an atrophic macular scar 3 disc diameters across. OS: Vertical C/D ratio is 0.1. There is 3+ optic nerve edema. There is a posterior vitreous separation. There is an atrophic macular scar 3 disc diameters across. There is also dilated retinal veins in all four quadrants with retinal hemorrhage in all four quadrants. OCT SCAN: The OCT scan of the right eye shows retinal atrophy. The left eye shows retinal atrophy with macular edema predominately nasal to the fovea. FLUORESCEIN ANGIOGRAM: FA of the left eye shows poor circulation with the re-circulation time of almost 20 seconds, which normal being less than 4 seconds. In the left eye there is also late leakage from the macular vessels. The perfusion in the periphery looks pretty good. I do not see greater than 10 areas of non-perfusion. The right eye has hyperfluorescence corresponding to the macular scar. IMPRESSION: 1. AGE-RELATED MACULAR DEGENERATION – BOTH EYES 2. CHRONIC MACULAR SCARS – BOTH EYES 3. NEW CENTRAL RETINAL VEIN OCCLUSION WITH MACULAR EDEMA AND OPTIC NERVE EDEMA – LEFT EYE DISCUSSION: I explained to the patient that unfortunately her left eye now in addition to her macular degeneration has a central retinal vein occlusion. Treatments at this moment for central retinal vein occlusions are not very good. Injectible Avastin and Lucentis will sometimes dry up the macula, but in the long term, the visual responses are often disappointing. Intravitreal Kenalog we will sometimes consider, but in patients who have possible glaucoma, the risk of the treatment may not be worth the potential benefits. There are some patients with central retinal vein occlusion who will improve on their own and I suggested we watch her closely and see which way the eye goes prior to instituting any sort of therapy. I asked her to return for a check in one month, sooner should she notice any problems. She will see you back periodically. I warned her there is a small possibility of neovascular glaucoma and should her eyes start to hurt and her vision decline and the eye become red, she should come back for urgent evaluation.