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72-year-old woman was seen in the office on December 1, 2010. She had cataract surgery done in the left eye October 5th of 2010. She had new glasses about a week after the surgery. She noticed at that time the vision wasn’t quite right and then subsequently if anything the vision in the left eye seems to be getting worse. She does have age-related macular degeneration. She takes vitamins for that. She is also in a Warrafin study where she is either receiving Warrafin or some other drug. It is a masked study. She has a history of a heart attack, high blood pressure, high cholesterol and lung disease. She does not at this moment smoke. VISUAL ACUITY: OD 20/50, OS 20/200. IOP: 12 OU. SLIT EXAMINATION: The right eye has a posterior chamber intraocular lens in good position. The left eye has 2+ nuclear sclerosis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is a posterior vitreous separation. There is a well circumbscribed elevated 800 micron yellow spot under the fovea. There is no subretinal fluid, hemorrhage or exudate. OS: Vertical C/D ratio is 0.2. There is a posterior vitreous separation. There is an inferotemporal macular branch retinal vein occlusion with 3+ cystoid macular edema and 2+ retinal hemorrhages. OCT SCAN: The OCT scan shows an average central foveal thickness in the left eye of 447 microns. The line scan in the right eye does show foveal atrophy overlying the subfoveal pigment spot. The left eye shows macular edema with intraretinal cysts, but no subretinal fluid. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography of the left eye shows no profusion in the inferotemporal quadrant of the macula from the branch retinal vein occlusion with some light leakage in the parafoveal capillaries. There is hypofluorescence where the hemorrhage is. The right eye shows the yellow spot in the fovea to be mostly hypofluorescence, although in the very late frames there is a little staining of it. IMPRESSION: 1. MACULAR BRANCH RETINAL VEIN OCCLUSION – LEFT EYE 2. MACULAR EDEMA – LEFT EYE 3. MACULAR HEMORRHAGE – LEFT EYE 4. CATARACT 5. PATTERN DYSTROPHY TYPE MACULAR DEGENERATION – RIGHT EYE Page 2 – John Smith December 6, 2010 DISCUSSION: I explained to the patient she does have a branch retinal vein occlusion with macular edema and macular hemorrhage. With intravitreal Lucentis there is about a 60 percent chance of her vision improving fifteen letters over the next six months with treatment. Without Lucentis the chance of improving that much is about 21 percent. Therefore, patients do better with treatment than without. I suggest we start the treatment now. She is going on a cruise Saturday, but she wanted to go ahead with the therapy. I told her there was probably not a huge harm waiting a few weeks, but there is some evidence that the sooner the treatment is done the better. I warned her there is a small risk about under one in a thousand of an infection in the eye and also because of her blood thinners her eye did get a little red with the injection. I treated the left eye with intravitreal injection of Lucentis (0.5 mg/0.05 ml) without any difficulty today. I asked her to return here again in one month or sooner should she notice a problem. She understands this is ongoing therapy. The fluorescein angiogram shows fairly poor perfusion inferotemporally.

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Pattern Dystrophy - Adult Vitelliform Macular Degeneration404 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
brvoandpatterndyst_jsm02.png
Pattern Dystrophy - Adult Vitelliform Macular Degeneration350 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
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Pattern Dystrophy - Adult Vitelliform Macular Degeneration216 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
brvoandpatterndyst_jsm04.png
Macular Branch Retinal Vein Occlusion and Adult Vitelliform Dystrophy206 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
brvoandpatterndyst_jsm05.jpg
Macular Branch Retinal Vein Occlusion and Adult Vitelliform Dystrophy118 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
brvoandpatterndyst_jsm06.jpg
Macular Branch Retinal Vein Occlusion and Adult Vitelliform Dystrophy106 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
brvoandpatterndyst_jsm07.jpg
Macular Branch Retinal Vein Occlusion and Adult Vitelliform Dystrophy104 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
brvoandpatterndyst_jsm08.jpg
Macular Branch Retinal Vein Occlusion and Adult Vitelliform Dystrophy93 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
brvoandpatterndyst_jsm09.png
Pattern Dystrophy - Adult Vitelliform Macular Degeneration178 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
brvoandpatterndyst_jsm10.png
Pattern Dystrophy - Adult Vitelliform Macular Degeneration162 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
brvoandpatterndyst_jsm11.png
Pattern Dystrophy - Adult Vitelliform Macular Degeneration137 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
brvoandpatterndyst_jsm12.png
Macular Branch Retinal Vein Occlusion and Adult Vitelliform Dystrophy104 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
brvoandpatterndyst_jsm13.png
Macular Branch Retinal Vein Occlusion and Adult Vitelliform Dystrophy90 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
brvoandpatterndyst_jsm14.jpg
Macular Branch Retinal Vein Occlusion and Adult Vitelliform Dystrophy108 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
brvoandpatterndyst_jsm15.png
Macular Branch Retinal Vein Occlusion and Adult Vitelliform Dystrophy102 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
brvoandpatterndyst_jsm16.png
Macular Branch Retinal Vein Occlusion and Adult Vitelliform Dystrophy73 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
brvoandpatterndyst_jsm17.png
Macular Branch Retinal Vein Occlusion and Adult Vitelliform Dystrophy58 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
brvoandpatterndyst_jsm18.png
Macular Branch Retinal Vein Occlusion and Adult Vitelliform Dystrophy80 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
brvoandpatterndyst_jsm19.png
Pattern Dystrophy - Adult Vitelliform Macular Degeneration80 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
brvoandpatterndyst_jsm20.png
Pattern Dystrophy - Adult Vitelliform Macular Degeneration77 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
brvoandpatterndyst_jsm21.png
Macular Branch Retinal Vein Occlusion and Adult Vitelliform Dystrophy58 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
brvoandpatterndyst_jsm22.png
Pattern Dystrophy - Adult Vitelliform Macular Degeneration84 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
brvoandpatterndyst_jsm23.png
Macular Branch Retinal Vein Occlusion and Adult Vitelliform Dystrophy120 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
brvoandpatterndyst_jsm24.jpg
Pattern Dystrophy - Adult Vitelliform Macular Degeneration165 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
brvoandpatterndyst_jsm25.jpg
Pattern Dystrophy - Adult Vitelliform Macular Degeneration174 views72-year-old woman 2 months post ECCE with poor vision since surgery especially left eye.
VISUAL ACUITY: OD 20/50, OS 20/200
00000
(0 votes)
     
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72-year-old woman was seen in the office on December 1, 2010. She had cataract surgery done in the left eye October 5th of 2010. She had new glasses about a week after the surgery. She noticed at that time the vision wasn’t quite right and then subsequently if anything the vision in the left eye seems to be getting worse. She does have age-related macular degeneration. She takes vitamins for that. She is also in a Warrafin study where she is either receiving Warrafin or some other drug. It is a masked study. She has a history of a heart attack, high blood pressure, high cholesterol and lung disease. She does not at this moment smoke. VISUAL ACUITY: OD 20/50, OS 20/200. IOP: 12 OU. SLIT EXAMINATION: The right eye has a posterior chamber intraocular lens in good position. The left eye has 2+ nuclear sclerosis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is a posterior vitreous separation. There is a well circumbscribed elevated 800 micron yellow spot under the fovea. There is no subretinal fluid, hemorrhage or exudate. OS: Vertical C/D ratio is 0.2. There is a posterior vitreous separation. There is an inferotemporal macular branch retinal vein occlusion with 3+ cystoid macular edema and 2+ retinal hemorrhages. OCT SCAN: The OCT scan shows an average central foveal thickness in the left eye of 447 microns. The line scan in the right eye does show foveal atrophy overlying the subfoveal pigment spot. The left eye shows macular edema with intraretinal cysts, but no subretinal fluid. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography of the left eye shows no profusion in the inferotemporal quadrant of the macula from the branch retinal vein occlusion with some light leakage in the parafoveal capillaries. There is hypofluorescence where the hemorrhage is. The right eye shows the yellow spot in the fovea to be mostly hypofluorescence, although in the very late frames there is a little staining of it. IMPRESSION: 1. MACULAR BRANCH RETINAL VEIN OCCLUSION – LEFT EYE 2. MACULAR EDEMA – LEFT EYE 3. MACULAR HEMORRHAGE – LEFT EYE 4. CATARACT 5. PATTERN DYSTROPHY TYPE MACULAR DEGENERATION – RIGHT EYE Page 2 – John Smith December 6, 2010 DISCUSSION: I explained to the patient she does have a branch retinal vein occlusion with macular edema and macular hemorrhage. With intravitreal Lucentis there is about a 60 percent chance of her vision improving fifteen letters over the next six months with treatment. Without Lucentis the chance of improving that much is about 21 percent. Therefore, patients do better with treatment than without. I suggest we start the treatment now. She is going on a cruise Saturday, but she wanted to go ahead with the therapy. I told her there was probably not a huge harm waiting a few weeks, but there is some evidence that the sooner the treatment is done the better. I warned her there is a small risk about under one in a thousand of an infection in the eye and also because of her blood thinners her eye did get a little red with the injection. I treated the left eye with intravitreal injection of Lucentis (0.5 mg/0.05 ml) without any difficulty today. I asked her to return here again in one month or sooner should she notice a problem. She understands this is ongoing therapy. The fluorescein angiogram shows fairly poor perfusion inferotemporally.