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80 Year Old Woman left eye vision is decreasing. She denies any new floaters, flashes or eye pain. OCULAR EXAM: Visual acuity with correction: OD: 2/200, PHNI; OS: 20/80, PHNI, J5. Intraocular pressure is 13 OD and 15 OS. SLIT LAMP EXAM: The anterior segments are quiet OU with 1-2+ nuclear sclerotic cataract OD and well-positioned PC IOL with trace PCO OS. DILATED FUNDUS EXAM: OD: C/D ratio is 0.2. PVD is present. Examination of the macula reveals extensive subretinal fluid from arcade to arcade with underlying disciform scarring. Hard exudates are noted along the boundaries of this lesion. Vessels are within normal limits and the periphery is attached with a well-demarcated operculated hole in the superior periphery. OS: C/D ratio is 0.2. Peripapillary atrophy is noted with subretinal fibrosis superonasal to the optic nerve head. Examination of the macula reveals a central layer of RPE atrophy, drusen, a dot hemorrhage inferonasal to fixation, as well as trace exudates inferotemporal to the foveal center approximately 1000 microns from the foveal center. Vessels are within normal limits and the periphery is attached 360. OCT SCAN: OS: The average central thickness is 251 microns with thinning centrally and RPE irregularity and drusen and no evidence of subretinal fluid. FLUORESCEIN ANGIOGRAPHY: Red-frees confirm clinical findings. There is transmission hyperfluorescence from RPE atrophy centrally and blockage from the dot hemorrhage inferonasal to the foveal center. There is stippled hyperfluorescence along the inferotemporal border of the atrophic lesion at an extrafoveal location. IMPRESSION: 1. AGE-RELATED MACULAR DEGENERATION: EXTENSIVE EXUDATIVE DISCIFORM SCARRING OD; NEW HEMORRHAGE AND EXUDATES IN EXTRAFOVEAL LOCATION OS. 2. FIBROSED PERIPAPILLARY CNVM OS. 3. NUCLEAR SCLEROTIC CATARACT OD, PSEUDOPHAKIA OS. DISCUSSION: The above findings were discussed in detail with the patient. I have asked her to return in 2-3 days for consideration of Macugen injection OS.

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80 Year Old Woman Macular Degeneration Disciform Scar - Fibrosis112 viewsVA 20/10000000
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80 Year Old Woman Macular Degeneration Disciform Scar - Fibrosis138 viewsVA 5/20000000
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80 Year Old Woman left eye vision is decreasing. She denies any new floaters, flashes or eye pain. OCULAR EXAM: Visual acuity with correction: OD: 2/200, PHNI; OS: 20/80, PHNI, J5. Intraocular pressure is 13 OD and 15 OS. SLIT LAMP EXAM: The anterior segments are quiet OU with 1-2+ nuclear sclerotic cataract OD and well-positioned PC IOL with trace PCO OS. DILATED FUNDUS EXAM: OD: C/D ratio is 0.2. PVD is present. Examination of the macula reveals extensive subretinal fluid from arcade to arcade with underlying disciform scarring. Hard exudates are noted along the boundaries of this lesion. Vessels are within normal limits and the periphery is attached with a well-demarcated operculated hole in the superior periphery. OS: C/D ratio is 0.2. Peripapillary atrophy is noted with subretinal fibrosis superonasal to the optic nerve head. Examination of the macula reveals a central layer of RPE atrophy, drusen, a dot hemorrhage inferonasal to fixation, as well as trace exudates inferotemporal to the foveal center approximately 1000 microns from the foveal center. Vessels are within normal limits and the periphery is attached 360. OCT SCAN: OS: The average central thickness is 251 microns with thinning centrally and RPE irregularity and drusen and no evidence of subretinal fluid. FLUORESCEIN ANGIOGRAPHY: Red-frees confirm clinical findings. There is transmission hyperfluorescence from RPE atrophy centrally and blockage from the dot hemorrhage inferonasal to the foveal center. There is stippled hyperfluorescence along the inferotemporal border of the atrophic lesion at an extrafoveal location. IMPRESSION: 1. AGE-RELATED MACULAR DEGENERATION: EXTENSIVE EXUDATIVE DISCIFORM SCARRING OD; NEW HEMORRHAGE AND EXUDATES IN EXTRAFOVEAL LOCATION OS. 2. FIBROSED PERIPAPILLARY CNVM OS. 3. NUCLEAR SCLEROTIC CATARACT OD, PSEUDOPHAKIA OS. DISCUSSION: The above findings were discussed in detail with the patient. I have asked her to return in 2-3 days for consideration of Macugen injection OS.