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70-year-old woman was seen in the office on August 4, 2010. She has noticed decreasing vision for the last week or two. She sees a spot straight ahead in the right eye and the vision in that eye is wavy and irregular and she is having difficulty seeing and difficulty reading. She is having difficulty seeing to the point where she has discontinued driving on her own about a week ago. VISUAL ACUITY: OD 20/200, OS 20/30. IOP: OD 14, OS 13. SLIT EXAMINATION: The right eye has a posterior chamber intraocular lens in good position with 1+ posterior capsular opacity. The left eye has 2+ nuclear sclerosis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.5. There is posterior vitreous separation and 2+ epiretinal membrane. OS: Vertical C/D ratio is 0.5. There is a posterior vitreous separation and 2+ epiretinal membrane. There is hemorrhage superonasal to the fovea and there is a superotemporal macular branch retinal vein occlusion. OCT SCAN: The OCT scan shows an increased central foveal thickness in the right eye of 452 microns and the left eye has 356 microns. Both with macular puckers and the right eye has macular edema. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows staining of the macula in the right eye in the late frames with leakage consistent with the macular pucker, but there is also some staining of the optic nerve, suggesting there maybe an inflammatory component to the macular edema. The left eye has reasonably good circulation with a little bit of a late leakage superonasal to the fovea, where the branch retinal vein occlusion is. IMPRESSION: 1. MACULAR PUCKERS – BOTH EYES 2. PSEUDOPHAKIC CYSTOID MACULAR EDEMA – RIGHT EYE 3. BRANCH RETINAL VEIN OCCLUSION – LEFT EYE DISCUSSION: I explained to the patient she does have a macular pucker in the right eye, which is significant and probably affecting her vision, but there may also be incomitant pseudophakic cystoid macular edema. I suggested a posterior sub-Tenon Kenalog injection behind the right eye to try and dry up the macula and improve the vision. If that doesn’t help I can discuss with her further the possibility to do macular pucker surgery. Post Surgery : 71-year-old woman had a vitrectomy for a macular pucker in the right eye September 29th. That eye is doing beautifully. She did have a new floater in that eye recently and you thought there might be a problem with her peripheral retina. The left eye since has been having decreasing vision. When I very first saw her in August, the left eye did have a branch retinal vein occlusion and macular pucker and macular edema, but the eye was doing better then than it is now and now that the right eye is doing so well, she is keyed into the poor vision in the left eye. VISUAL ACUITY: OD 20/30, OS 20/40. IOP: OD 11, OS 13. The right eye has a posterior chamber intraocular lens in good position with open capsule. The left eye has 2+ nuclear sclerosis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.5. There is a retinal flap tear at 12 o’clock at the equator with vitreoretinal traction around it. OS: Vertical C/D ratio is 0.5. There is a superotemporal macular branch retinal vein occlusion with edema and overlying epiretinal membrane. OCT SCAN: The OCT scan shows an average central foveal thickness in the right eye of 281 microns with a volume of 7.1. The left eye has 385 microns with a volume of 7.56. The left volume is worse than it has been in the past. IMPRESSION: 1. NEW RETINAL TEAR – RIGHT EYE 2. PREVIOUS VITRECTOMY – RIGHT EYE 3. EXCELLENT MACULAR PUCKER SURGERY IN THE RETINA – RIGHT EYE 4. MACULAR PUCKER – LEFT EYE 5. MACULAR EDEMA – LEFT EYE 6. BRANCH RETINAL VEIN OCCLUSION – LEFT EYE DISCUSSION: I explained to the patient the right eye has a high risk retinal tear. With laser treatment I could reduce the risk of retinal detachment from that tear. We talked about the risks, benefits, indications, and alternatives of prophylactic laser and the patient agreed to this procedure after the questions were answered. Prophylactic laser was performed today on the right eye without difficulty. I asked her to return for a check in one week and I will inject that eye with Lucentis and start a six month course of therapy in the hopes of improving the visual acuity in that eye.

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70-year-old woman was seen in the office on August 4, 2010. She has noticed decreasing vision for the last week or two. She sees a spot straight ahead in the right eye and the vision in that eye is wavy and irregular and she is having difficulty seeing and difficulty reading. She is having difficulty seeing to the point where she has discontinued driving on her own about a week ago. VISUAL ACUITY: OD 20/200, OS 20/30. IOP: OD 14, OS 13. SLIT EXAMINATION: The right eye has a posterior chamber intraocular lens in good position with 1+ posterior capsular opacity. The left eye has 2+ nuclear sclerosis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.5. There is posterior vitreous separation and 2+ epiretinal membrane. OS: Vertical C/D ratio is 0.5. There is a posterior vitreous separation and 2+ epiretinal membrane. There is hemorrhage superonasal to the fovea and there is a superotemporal macular branch retinal vein occlusion. OCT SCAN: The OCT scan shows an increased central foveal thickness in the right eye of 452 microns and the left eye has 356 microns. Both with macular puckers and the right eye has macular edema. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows staining of the macula in the right eye in the late frames with leakage consistent with the macular pucker, but there is also some staining of the optic nerve, suggesting there maybe an inflammatory component to the macular edema. The left eye has reasonably good circulation with a little bit of a late leakage superonasal to the fovea, where the branch retinal vein occlusion is. IMPRESSION: 1. MACULAR PUCKERS – BOTH EYES 2. PSEUDOPHAKIC CYSTOID MACULAR EDEMA – RIGHT EYE 3. BRANCH RETINAL VEIN OCCLUSION – LEFT EYE DISCUSSION: I explained to the patient she does have a macular pucker in the right eye, which is significant and probably affecting her vision, but there may also be incomitant pseudophakic cystoid macular edema. I suggested a posterior sub-Tenon Kenalog injection behind the right eye to try and dry up the macula and improve the vision. If that doesn’t help I can discuss with her further the possibility to do macular pucker surgery. Post Surgery : 71-year-old woman had a vitrectomy for a macular pucker in the right eye September 29th. That eye is doing beautifully. She did have a new floater in that eye recently and you thought there might be a problem with her peripheral retina. The left eye since has been having decreasing vision. When I very first saw her in August, the left eye did have a branch retinal vein occlusion and macular pucker and macular edema, but the eye was doing better then than it is now and now that the right eye is doing so well, she is keyed into the poor vision in the left eye. VISUAL ACUITY: OD 20/30, OS 20/40. IOP: OD 11, OS 13. The right eye has a posterior chamber intraocular lens in good position with open capsule. The left eye has 2+ nuclear sclerosis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.5. There is a retinal flap tear at 12 o’clock at the equator with vitreoretinal traction around it. OS: Vertical C/D ratio is 0.5. There is a superotemporal macular branch retinal vein occlusion with edema and overlying epiretinal membrane. OCT SCAN: The OCT scan shows an average central foveal thickness in the right eye of 281 microns with a volume of 7.1. The left eye has 385 microns with a volume of 7.56. The left volume is worse than it has been in the past. IMPRESSION: 1. NEW RETINAL TEAR – RIGHT EYE 2. PREVIOUS VITRECTOMY – RIGHT EYE 3. EXCELLENT MACULAR PUCKER SURGERY IN THE RETINA – RIGHT EYE 4. MACULAR PUCKER – LEFT EYE 5. MACULAR EDEMA – LEFT EYE 6. BRANCH RETINAL VEIN OCCLUSION – LEFT EYE DISCUSSION: I explained to the patient the right eye has a high risk retinal tear. With laser treatment I could reduce the risk of retinal detachment from that tear. We talked about the risks, benefits, indications, and alternatives of prophylactic laser and the patient agreed to this procedure after the questions were answered. Prophylactic laser was performed today on the right eye without difficulty. I asked her to return for a check in one week and I will inject that eye with Lucentis and start a six month course of therapy in the hopes of improving the visual acuity in that eye.