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The patient is a very pleasant 86-year-old with a history of decreased vision in the right eye. The patient reports she has lost vision in the right eye over the past two months or so. She reports the vision was always compromised in that eye since retinal detachment surgery in 1960, but overall the vision had been much better centrally. She reports that the right eye has always had a visual field defect on the nasal side of it but that the central vision was not as poor as it is now. This is supported by your old notes which show she had a visual acuity on Snellen testing in your office of 20/50 on the right side. As you know, The patient had cataract extraction in 1996 in the right and 1999 in the left. She reports the retinal detachment surgery involved a week-long hospitalization in which both of her eyes were patched. She reports she had tear duct laser procedures as well. Visual acuity with correction of 10/200 OD, 20/25 OS. IOP: 19 OD, 17 OS. SLIT LAMP EXAM: Biomicroscopy reveals a quiet anterior segment on both sides with a stable IOL. The anterior vitreous is syneretic. POSTERIOR SEGMENT EXAM: There is a PVD present in both eyes. C/D ratio is 0.4 OD, 0.3 OS. Large retinal vasculature appears patent with attenuation of vessels and areas of atrophy in the right macula. The right side shows a PED with some subretinal hemorrhage around it on the edge of a very significant vertical macular scar with atrophy and hyperpigmentation anterior to it extending into the temporal periphery. The left eye has drusen present in the central macula with some confluence and soft characteristics. EXTENDED OPHTHALMOSCOPY: The retinal periphery shows a remarkable area of hyper- and hypopigmentation with pigmentary scarring present throughout the temporal half of the retina in the right eye. There is no buckling present and there is no vitrectomy seen. The left eye shows no tears, breaks, or detachments. There is a small area of subretinal hemorrhage superior to the optic nerve on the left eye. OCT SCAN: There is a significantly attenuated macular region temporally with a PED present at the border of attenuated and normal retinal pigment epithelium. The left eye has a smooth and compact neurosensory retinal layer with some dropout of photoreceptors and minimal drusenoid RPE elevations. FUNDUS PHOTOGRAPHY: Color and red-free photographs correspond to clinical findings and show peripheral pigmentary scarring in the temporal macula with some hemorrhage in the central macula on the right side and drusen on the left side with minimal subretinal hemorrhage left side. FLUORESCEIN ANGIOGRAPHY: The right eye is transit. Arm-to-eye time and AV transit time are within normal limits. There is classic-type hyperfluorescence of the foveal membrane in the right eye. As the study progresses, there is leakage of this fairly copiously in the mid and late phases of the angiogram. There is mottled hyperfluorescence corresponding to the areas of pigmentary scarring in the temporal macula. The left eye has staining of drusen and no leakage in the peripapillary region. There is minimal blocking corresponding to the very small subretinal hemorrhage. IMPRESSION: 1. NEW ONSET ADVANCED WET AGE-RELATED MACULAR DEGENERATION 2. ACTIVE CHOROIDAL NEOVASCULAR PROCESS RIGHT EYE 3. FIBROVASCULAR PIGMENT EPITHELIAL DETACHMENT RIGHT EYE AT BORDER OF MACULAR SCAR 4. SUBRETINAL HEMORRHAGE INDICATIVE OF NEW ACTIVITY 5. PERIPAPILLARY SUBRETINAL HEMORRHAGE WITHOUT CHOROIDAL NEOVASCULAR ACTIVITY LEFT SIDE 6. MACULAR DRUSEN LEFT SIDE 7. REMOTE RETINAL DETACHMENT REPAIR RIGHT EYE 8. OPEN ANGLE GLAUCOMA SUSPECT LEFT EYE I gave her some treatment options, including reduced-fluence photodynamic therapy, antiangiogenic agents, and combination therapy. I explained that the right eye probably was prone to this problem because of the macular scarring. I explained the left eye probably has a significant risk for wet macular degeneration but is probably less than 50% seen in classic nonsurgical patients with onset wet disease in one eye. I recommended she consume antioxidant supplements to reduce her risk of aggressive macular degenerative disease. I am going to have The patient come back in a couple of days after she starts some antibiotics and thinks about her treatment options. I am going to have her continue to keep up with you, and I told her how impressed I was that her retinal detachment repair went so well when it was performed 51 years ago.

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Choriodal Neovascular Membrane - Subfoveal - Pseudo-Retinitis Pigmentosa - 50 years post Retinal Detachment Repair173 views86-year-old with a history of decreased vision in the right eye. The patient reports she has lost vision in the right eye over the past two months or so. She reports the vision was always compromised in that eye since retinal detachment surgery 50 years ago with a scleral buckler. Vision dropped from 20/50 to 20/200 right eye in 2 months.
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Choriodal Neovascular Membrane - Subfoveal - Pseudo-Retinitis Pigmentosa - 50 years post Retinal Detachment Repair120 views86-year-old with a history of decreased vision in the right eye. The patient reports she has lost vision in the right eye over the past two months or so. She reports the vision was always compromised in that eye since retinal detachment surgery 50 years ago with a scleral buckler. Vision dropped from 20/50 to 20/200 right eye in 2 months.
55555
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Choriodal Neovascular Membrane - Subfoveal - Pseudo-Retinitis Pigmentosa - 50 years post Retinal Detachment Repair160 views86-year-old with a history of decreased vision in the right eye. The patient reports she has lost vision in the right eye over the past two months or so. She reports the vision was always compromised in that eye since retinal detachment surgery 50 years ago with a scleral buckler. Vision dropped from 20/50 to 20/200 right eye in 2 months.
11111
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Choriodal Neovascular Membrane - Subfoveal - Pseudo-Retinitis Pigmentosa - 50 years post Retinal Detachment Repair90 views86-year-old with a history of decreased vision in the right eye. The patient reports she has lost vision in the right eye over the past two months or so. She reports the vision was always compromised in that eye since retinal detachment surgery 50 years ago with a scleral buckler. Vision dropped from 20/50 to 20/200 right eye in 2 months.
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Choriodal Neovascular Membrane - Subfoveal - Pseudo-Retinitis Pigmentosa - 50 years post Retinal Detachment Repair68 views86-year-old with a history of decreased vision in the right eye. The patient reports she has lost vision in the right eye over the past two months or so. She reports the vision was always compromised in that eye since retinal detachment surgery 50 years ago with a scleral buckler. Vision dropped from 20/50 to 20/200 right eye in 2 months.
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Choriodal Neovascular Membrane - Subfoveal - Pseudo-Retinitis Pigmentosa - 50 years post Retinal Detachment Repair62 views86-year-old with a history of decreased vision in the right eye. The patient reports she has lost vision in the right eye over the past two months or so. She reports the vision was always compromised in that eye since retinal detachment surgery 50 years ago with a scleral buckler. Vision dropped from 20/50 to 20/200 right eye in 2 months.
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Choriodal Neovascular Membrane - Subfoveal - Pseudo-Retinitis Pigmentosa - 50 years post Retinal Detachment Repair47 views86-year-old with a history of decreased vision in the right eye. The patient reports she has lost vision in the right eye over the past two months or so. She reports the vision was always compromised in that eye since retinal detachment surgery 50 years ago with a scleral buckler. Vision dropped from 20/50 to 20/200 right eye in 2 months.
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Choriodal Neovascular Membrane - Subfoveal - Pseudo-Retinitis Pigmentosa - 50 years post Retinal Detachment Repair108 views86-year-old with a history of decreased vision in the right eye. The patient reports she has lost vision in the right eye over the past two months or so. She reports the vision was always compromised in that eye since retinal detachment surgery 50 years ago with a scleral buckler. Vision dropped from 20/50 to 20/200 right eye in 2 months.
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Choriodal Neovascular Membrane - Subfoveal - Pseudo-Retinitis Pigmentosa - 50 years post Retinal Detachment Repair39 views86-year-old with a history of decreased vision in the right eye. The patient reports she has lost vision in the right eye over the past two months or so. She reports the vision was always compromised in that eye since retinal detachment surgery 50 years ago with a scleral buckler. Vision dropped from 20/50 to 20/200 right eye in 2 months.
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Choriodal Neovascular Membrane - Subfoveal - Pseudo-Retinitis Pigmentosa - 50 years post Retinal Detachment Repair64 views86-year-old with a history of decreased vision in the right eye. The patient reports she has lost vision in the right eye over the past two months or so. She reports the vision was always compromised in that eye since retinal detachment surgery 50 years ago with a scleral buckler. Vision dropped from 20/50 to 20/200 right eye in 2 months.
55555
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oldrdcnvm_done11.jpg
Choriodal Neovascular Membrane - Subfoveal - Pseudo-Retinitis Pigmentosa - 50 years post Retinal Detachment Repair59 views86-year-old with a history of decreased vision in the right eye. The patient reports she has lost vision in the right eye over the past two months or so. She reports the vision was always compromised in that eye since retinal detachment surgery 50 years ago with a scleral buckler. Vision dropped from 20/50 to 20/200 right eye in 2 months.
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Choriodal Neovascular Membrane - Subfoveal - Pseudo-Retinitis Pigmentosa - 50 years post Retinal Detachment Repair34 views86-year-old with a history of decreased vision in the right eye. The patient reports she has lost vision in the right eye over the past two months or so. She reports the vision was always compromised in that eye since retinal detachment surgery 50 years ago with a scleral buckler. Vision dropped from 20/50 to 20/200 right eye in 2 months.
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Choriodal Neovascular Membrane - Subfoveal - Pseudo-Retinitis Pigmentosa - 50 years post Retinal Detachment Repair33 views86-year-old with a history of decreased vision in the right eye. The patient reports she has lost vision in the right eye over the past two months or so. She reports the vision was always compromised in that eye since retinal detachment surgery 50 years ago with a scleral buckler. Vision dropped from 20/50 to 20/200 right eye in 2 months.
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Choriodal Neovascular Membrane - Subfoveal - Pseudo-Retinitis Pigmentosa - 50 years post Retinal Detachment Repair56 views86-year-old with a history of decreased vision in the right eye. The patient reports she has lost vision in the right eye over the past two months or so. She reports the vision was always compromised in that eye since retinal detachment surgery 50 years ago with a scleral buckler. Vision dropped from 20/50 to 20/200 right eye in 2 months.
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oldrdcnvm_done15.jpg
Choriodal Neovascular Membrane - Subfoveal - Pseudo-Retinitis Pigmentosa - 50 years post Retinal Detachment Repair48 views86-year-old with a history of decreased vision in the right eye. The patient reports she has lost vision in the right eye over the past two months or so. She reports the vision was always compromised in that eye since retinal detachment surgery 50 years ago with a scleral buckler. Vision dropped from 20/50 to 20/200 right eye in 2 months.
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oldrdcnvm_done16.jpg
Choriodal Neovascular Membrane - Subfoveal - Pseudo-Retinitis Pigmentosa - 50 years post Retinal Detachment Repair85 views86-year-old with a history of decreased vision in the right eye. The patient reports she has lost vision in the right eye over the past two months or so. She reports the vision was always compromised in that eye since retinal detachment surgery 50 years ago with a scleral buckler. Vision dropped from 20/50 to 20/200 right eye in 2 months.
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Choriodal Neovascular Membrane - Subfoveal - Pseudo-Retinitis Pigmentosa - 50 years post Retinal Detachment Repair90 views86-year-old with a history of decreased vision in the right eye. The patient reports she has lost vision in the right eye over the past two months or so. She reports the vision was always compromised in that eye since retinal detachment surgery 50 years ago with a scleral buckler. Vision dropped from 20/50 to 20/200 right eye in 2 months.
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Choriodal Neovascular Membrane - Subfoveal - Pseudo-Retinitis Pigmentosa - 50 years post Retinal Detachment Repair107 views86-year-old with a history of decreased vision in the right eye. The patient reports she has lost vision in the right eye over the past two months or so. She reports the vision was always compromised in that eye since retinal detachment surgery 50 years ago with a scleral buckler. Vision dropped from 20/50 to 20/200 right eye in 2 months.
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The patient is a very pleasant 86-year-old with a history of decreased vision in the right eye. The patient reports she has lost vision in the right eye over the past two months or so. She reports the vision was always compromised in that eye since retinal detachment surgery in 1960, but overall the vision had been much better centrally. She reports that the right eye has always had a visual field defect on the nasal side of it but that the central vision was not as poor as it is now. This is supported by your old notes which show she had a visual acuity on Snellen testing in your office of 20/50 on the right side. As you know, The patient had cataract extraction in 1996 in the right and 1999 in the left. She reports the retinal detachment surgery involved a week-long hospitalization in which both of her eyes were patched. She reports she had tear duct laser procedures as well. Visual acuity with correction of 10/200 OD, 20/25 OS. IOP: 19 OD, 17 OS. SLIT LAMP EXAM: Biomicroscopy reveals a quiet anterior segment on both sides with a stable IOL. The anterior vitreous is syneretic. POSTERIOR SEGMENT EXAM: There is a PVD present in both eyes. C/D ratio is 0.4 OD, 0.3 OS. Large retinal vasculature appears patent with attenuation of vessels and areas of atrophy in the right macula. The right side shows a PED with some subretinal hemorrhage around it on the edge of a very significant vertical macular scar with atrophy and hyperpigmentation anterior to it extending into the temporal periphery. The left eye has drusen present in the central macula with some confluence and soft characteristics. EXTENDED OPHTHALMOSCOPY: The retinal periphery shows a remarkable area of hyper- and hypopigmentation with pigmentary scarring present throughout the temporal half of the retina in the right eye. There is no buckling present and there is no vitrectomy seen. The left eye shows no tears, breaks, or detachments. There is a small area of subretinal hemorrhage superior to the optic nerve on the left eye. OCT SCAN: There is a significantly attenuated macular region temporally with a PED present at the border of attenuated and normal retinal pigment epithelium. The left eye has a smooth and compact neurosensory retinal layer with some dropout of photoreceptors and minimal drusenoid RPE elevations. FUNDUS PHOTOGRAPHY: Color and red-free photographs correspond to clinical findings and show peripheral pigmentary scarring in the temporal macula with some hemorrhage in the central macula on the right side and drusen on the left side with minimal subretinal hemorrhage left side. FLUORESCEIN ANGIOGRAPHY: The right eye is transit. Arm-to-eye time and AV transit time are within normal limits. There is classic-type hyperfluorescence of the foveal membrane in the right eye. As the study progresses, there is leakage of this fairly copiously in the mid and late phases of the angiogram. There is mottled hyperfluorescence corresponding to the areas of pigmentary scarring in the temporal macula. The left eye has staining of drusen and no leakage in the peripapillary region. There is minimal blocking corresponding to the very small subretinal hemorrhage. IMPRESSION: 1. NEW ONSET ADVANCED WET AGE-RELATED MACULAR DEGENERATION 2. ACTIVE CHOROIDAL NEOVASCULAR PROCESS RIGHT EYE 3. FIBROVASCULAR PIGMENT EPITHELIAL DETACHMENT RIGHT EYE AT BORDER OF MACULAR SCAR 4. SUBRETINAL HEMORRHAGE INDICATIVE OF NEW ACTIVITY 5. PERIPAPILLARY SUBRETINAL HEMORRHAGE WITHOUT CHOROIDAL NEOVASCULAR ACTIVITY LEFT SIDE 6. MACULAR DRUSEN LEFT SIDE 7. REMOTE RETINAL DETACHMENT REPAIR RIGHT EYE 8. OPEN ANGLE GLAUCOMA SUSPECT LEFT EYE I gave her some treatment options, including reduced-fluence photodynamic therapy, antiangiogenic agents, and combination therapy. I explained that the right eye probably was prone to this problem because of the macular scarring. I explained the left eye probably has a significant risk for wet macular degeneration but is probably less than 50% seen in classic nonsurgical patients with onset wet disease in one eye. I recommended she consume antioxidant supplements to reduce her risk of aggressive macular degenerative disease. I am going to have The patient come back in a couple of days after she starts some antibiotics and thinks about her treatment options. I am going to have her continue to keep up with you, and I told her how impressed I was that her retinal detachment repair went so well when it was performed 51 years ago.