Myopic Degeneration - Dry - Atrophy Staphyloma - Myopic Tractional Maculopathy
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58-year-old woman was seen in the office on June 30, 2011. When she was very young her vision never corrected to 20/20 and then in 1982 she was fitted for gas permeable contact lenses and she was able to see well enough to drive. She saw well until around 2002, at which point the lenses were no longer affective and she had a clear lens exchange , at which point her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. She possibly attributed it to different medication she was taking, but since it is no better she comes in for an evaluation. She does take fish oil as well as other medications.
VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16. IOP: OD 13, OS 12.
SLIT EXAMINATION: The posterior chamber intraocular lens is in good position in both eyes with open capsules.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.1. There is peripapillary atrophy. There is a posterior staphyloma. There is lattice degeneration inferotemporally peripherally.
OS: Vertical C/D ratio is 0.1. There is peripapillary atrophy. There is a posterior staphyloma. There is lattice degeneration inferotemporally.
OCT SCAN: The OCT scan shows stretching of the photoreceptors in both eyes consistent with myopic tractional maculopathy with non foveal retinal detachments, worse in the left eye than the right eye. Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows hyperfluorescence corresponding to the areas of atrophy. There is no clear evidence of any neovascularization in either eye.
IMPRESSION:
1. RETINAL DETACHMENTS – WORSE IN THE LEFT EYE THAN THE RIGHT EYE
2. VISION LOSS – LEFT EYE
3. POSSIBLE MYOPIC TRACTIONAL MACULOPATHY
4. POSSIBLE OCCULT SUBRETINAL CHOROIDAL NEOVASCULAR MEMBRANE – LEFT EYE
DISCUSSION: I explained to the patient with subretinal fluid in the left eye and the vision loss, the most likely explanation is an occult subretinal choroidal neovascular membrane associated with her high myopia and the treatment for that would be intravitreal injections, which are relatively low risk. It is also possible she has myopic tractional maculopathy, which is less common and treatment for that is a vitrectomy.
The treatment for the more common disease is safer, I suggest we try a series of three Avastin treatments to see if that will improve the vision and induce absorption of subretinal fluid. I treated the left eye with intravitreal injection of Avastin (1.25 mg/0.05 ml) without any difficulty today.
I asked her to return for a check in one month or sooner should she notice a problem. After three treatments she is no better, I will probably consider a vitrectomy with a gas bubble in that eye.
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane717 views58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.
(0 votes)
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane601 views58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.
(0 votes)
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane469 views58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.
(0 votes)
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane507 views58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.
(0 votes)
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane544 views58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.
(0 votes)
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane585 views58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.
(0 votes)
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane452 views58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.
(0 votes)
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane481 views58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.
(0 votes)
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane402 views58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.
(0 votes)
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane450 views58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.
(0 votes)
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane481 views58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.
(0 votes)
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane379 views58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.
(0 votes)
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane403 views58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.
(0 votes)
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane401 views58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.
(0 votes)
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane457 views58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.
(0 votes)
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane384 views58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.
(0 votes)
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane379 views58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.
(0 votes)
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane420 views58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.
(0 votes)
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane455 views58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.
(0 votes)
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane405 views58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.
(0 votes)
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane555 views58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.
(0 votes)
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58-year-old woman was seen in the office on June 30, 2011. When she was very young her vision never corrected to 20/20 and then in 1982 she was fitted for gas permeable contact lenses and she was able to see well enough to drive. She saw well until around 2002, at which point the lenses were no longer affective and she had a clear lens exchange , at which point her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. She possibly attributed it to different medication she was taking, but since it is no better she comes in for an evaluation. She does take fish oil as well as other medications.
VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16. IOP: OD 13, OS 12.
SLIT EXAMINATION: The posterior chamber intraocular lens is in good position in both eyes with open capsules.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.1. There is peripapillary atrophy. There is a posterior staphyloma. There is lattice degeneration inferotemporally peripherally.
OS: Vertical C/D ratio is 0.1. There is peripapillary atrophy. There is a posterior staphyloma. There is lattice degeneration inferotemporally.
OCT SCAN: The OCT scan shows stretching of the photoreceptors in both eyes consistent with myopic tractional maculopathy with non foveal retinal detachments, worse in the left eye than the right eye. Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows hyperfluorescence corresponding to the areas of atrophy. There is no clear evidence of any neovascularization in either eye.
IMPRESSION:
1. RETINAL DETACHMENTS – WORSE IN THE LEFT EYE THAN THE RIGHT EYE
2. VISION LOSS – LEFT EYE
3. POSSIBLE MYOPIC TRACTIONAL MACULOPATHY
4. POSSIBLE OCCULT SUBRETINAL CHOROIDAL NEOVASCULAR MEMBRANE – LEFT EYE
DISCUSSION: I explained to the patient with subretinal fluid in the left eye and the vision loss, the most likely explanation is an occult subretinal choroidal neovascular membrane associated with her high myopia and the treatment for that would be intravitreal injections, which are relatively low risk. It is also possible she has myopic tractional maculopathy, which is less common and treatment for that is a vitrectomy.
The treatment for the more common disease is safer, I suggest we try a series of three Avastin treatments to see if that will improve the vision and induce absorption of subretinal fluid. I treated the left eye with intravitreal injection of Avastin (1.25 mg/0.05 ml) without any difficulty today.
I asked her to return for a check in one month or sooner should she notice a problem. After three treatments she is no better, I will probably consider a vitrectomy with a gas bubble in that eye.
