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87-year-old woman has wet age-related macular degeneration in the left eye. She had treatment up north but there has been a gap in therapy and the vision in the left eye is poor. The vision in the right eye remains good. VISUAL ACUITY: Vision OD is 20/25, OS is 20/400. IOP: OU 18. The posterior chamber intraocular lens is in good position in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There are hyperpigmented spots in the macula. There is no intraretinal or subretinal fluid. OS: Vertical C/D ratio is 0.1. There is a pigment epithelial detachment centrally with exudate at the edge as well as subretinal fluid and hemorrhage. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAM: Shows an occult subfoveal choroidal neovascular membrane in the left eye about 4 disc areas in size. The right eye has staining of drusen and hypofluorescence corresponding to the macular pigment. Temporal to the fovea, about 1-disc diameter from the center, there is a disc area of irregular hyperfluorescence. It is associated with a spot of hemorrhage, which may represent an occult asymptomatic extrafoveal choroidal neovascular membrane. IMPRESSION: 1. WET AGE-RELATED MACULAR DEGENERATION – LEFT EYE 2. PIGMENT EPITHELIAL DETACHMENT – LEFT EYE 3. SEROUS MACULAR DETEACHMENT – LEFT EYE 4. MACULAR HEMORRHAGE – LEFT EYE 5. DRY AGE-RELATED MACULAR DEGENERATION WITH HIGH-RISK CHARACTERISTICS 6. POSSIBLE OCCULT EXTRAFOVEAL CHOROIDAL NEOVASCULAR MEMBRANE – RIGHT EYE DISCUSSION: I explained to the patient the macula in the left eye is wet. With intravitreal injections there is an excellent chance of maintaining her vision and possibly improving it. I treated with intravitreal injection of Avastin (1.25 mg/0.05 ml) without any difficulty today.

dryamdpighy_esei01.jpg
Hyperpigmentation of the Retinal Pigment Epithelium in Dry AMD254 views87-year-old woman has wet age-related macular degeneration in the left eye. Vision OD is 20/25, OS is 20/40000000
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dryamdpighy_esei02.jpg
Hyperpigmentation of the Retinal Pigment Epithelium in Dry AMD219 views87-year-old woman has wet age-related macular degeneration in the left eye. Vision OD is 20/25, OS is 20/40000000
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dryamdpighy_esei03.jpg
Hyperpigmentation of the Retinal Pigment Epithelium in Dry AMD193 views87-year-old woman has wet age-related macular degeneration in the left eye. Vision OD is 20/25, OS is 20/40000000
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dryamdpighy_esei04.jpg
Hyperpigmentation of the Retinal Pigment Epithelium in Dry AMD123 views87-year-old woman has wet age-related macular degeneration in the left eye. Vision OD is 20/25, OS is 20/40000000
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dryamdpighy_esei05.jpg
Hyperpigmentation of the Retinal Pigment Epithelium in Dry AMD97 views87-year-old woman has wet age-related macular degeneration in the left eye. Vision OD is 20/25, OS is 20/40000000
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dryamdpighy_esei06.jpg
Hyperpigmentation of the Retinal Pigment Epithelium in Dry AMD89 views87-year-old woman has wet age-related macular degeneration in the left eye. Vision OD is 20/25, OS is 20/40000000
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dryamdpighy_esei07.jpg
Hyperpigmentation of the Retinal Pigment Epithelium in Dry AMD102 views87-year-old woman has wet age-related macular degeneration in the left eye. Vision OD is 20/25, OS is 20/40000000
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dryamdpighy_esei08.jpg
Hyperpigmentation of the Retinal Pigment Epithelium in Dry AMD81 views87-year-old woman has wet age-related macular degeneration in the left eye. Vision OD is 20/25, OS is 20/40000000
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dryamdpighy_esei09.jpg
Hyperpigmentation of the Retinal Pigment Epithelium in Dry AMD94 views87-year-old woman has wet age-related macular degeneration in the left eye. Vision OD is 20/25, OS is 20/40000000
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wetamdped_esei01.jpg
Wet AMD - PED with exudate 20/400 87 Year old114 views87-year-old woman has wet age-related macular degeneration in the left eye. Vision OD is 20/25, OS is 20/40000000
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wetamdped_esei02.jpg
Wet AMD - PED with exudate 20/400 87 Year old142 views87-year-old woman has wet age-related macular degeneration in the left eye. Vision OD is 20/25, OS is 20/40000000
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wetamdped_esei03.jpg
Wet AMD - PED with exudate 20/400 87 Year old100 views87-year-old woman has wet age-related macular degeneration in the left eye. Vision OD is 20/25, OS is 20/40000000
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wetamdped_esei04.jpg
Wet AMD - PED with exudate 20/400 87 Year old99 views87-year-old woman has wet age-related macular degeneration in the left eye. Vision OD is 20/25, OS is 20/40000000
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wetamdped_esei05.jpg
Wet AMD - PED with exudate 20/400 87 Year old106 views87-year-old woman has wet age-related macular degeneration in the left eye. Vision OD is 20/25, OS is 20/40000000
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wetamdped_esei06.jpg
Wet AMD - PED with exudate 20/400 87 Year old133 views87-year-old woman has wet age-related macular degeneration in the left eye. Vision OD is 20/25, OS is 20/40000000
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wetamdped_esei07.jpg
Wet AMD - PED with exudate 20/400 87 Year old65 views87-year-old woman has wet age-related macular degeneration in the left eye. Vision OD is 20/25, OS is 20/40000000
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wetamdped_esei08.jpg
Wet AMD - PED with exudate 20/400 87 Year old92 views87-year-old woman has wet age-related macular degeneration in the left eye. Vision OD is 20/25, OS is 20/40000000
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wetamdped_esei09.jpg
Wet AMD - PED with exudate 20/400 87 Year old86 views87-year-old woman has wet age-related macular degeneration in the left eye. Vision OD is 20/25, OS is 20/40000000
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wetamdped_esei10.jpg
Wet AMD - PED with exudate 20/400 87 Year old119 views87-year-old woman has wet age-related macular degeneration in the left eye. Vision OD is 20/25, OS is 20/40000000
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87-year-old woman has wet age-related macular degeneration in the left eye. She had treatment up north but there has been a gap in therapy and the vision in the left eye is poor. The vision in the right eye remains good. VISUAL ACUITY: Vision OD is 20/25, OS is 20/400. IOP: OU 18. The posterior chamber intraocular lens is in good position in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There are hyperpigmented spots in the macula. There is no intraretinal or subretinal fluid. OS: Vertical C/D ratio is 0.1. There is a pigment epithelial detachment centrally with exudate at the edge as well as subretinal fluid and hemorrhage. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAM: Shows an occult subfoveal choroidal neovascular membrane in the left eye about 4 disc areas in size. The right eye has staining of drusen and hypofluorescence corresponding to the macular pigment. Temporal to the fovea, about 1-disc diameter from the center, there is a disc area of irregular hyperfluorescence. It is associated with a spot of hemorrhage, which may represent an occult asymptomatic extrafoveal choroidal neovascular membrane. IMPRESSION: 1. WET AGE-RELATED MACULAR DEGENERATION – LEFT EYE 2. PIGMENT EPITHELIAL DETACHMENT – LEFT EYE 3. SEROUS MACULAR DETEACHMENT – LEFT EYE 4. MACULAR HEMORRHAGE – LEFT EYE 5. DRY AGE-RELATED MACULAR DEGENERATION WITH HIGH-RISK CHARACTERISTICS 6. POSSIBLE OCCULT EXTRAFOVEAL CHOROIDAL NEOVASCULAR MEMBRANE – RIGHT EYE DISCUSSION: I explained to the patient the macula in the left eye is wet. With intravitreal injections there is an excellent chance of maintaining her vision and possibly improving it. I treated with intravitreal injection of Avastin (1.25 mg/0.05 ml) without any difficulty today.