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88-year-old man was seen in the office on 9/2/2011. He has had glaucoma for several years. He had surgery for that some time ago. He has noticed for the last few months the vision in the right eye is foggy, like there is a film in the eye or a haze, and he does not see well out of the eye. His left eye is also a little bit foggy. He has been diabetic for sixteen years. He stopped his aspirin recently for an ear procedure. VISUAL ACUITY: His vision is 20/16 in each eye. IOP: 13 in both eyes. AMSLER GRID: Normal in both eyes. SLIT LAMP EXAM: There are functioning filtering blebs in both eyes with the posterior chamber intraocular lens in good position in both eyes with open capsules. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.7. The nerve is pale. There are 1+ macular drusen. There is no diabetic retinopathy. In the inferotemporal periphery there is a hemorrhage at the equator at about 7:00 o’clock, which is about 4-disc diameters across and adjacent to that there is scarring. OS: Vertical C/D ratio is 0.7. There is a posterior vitreous separation. There is a fairly extensive disciform scar in the periphery. Inferotemporally there are 1+ macular drusen. OCT SCAN: The OCT scan of the macula is normal in both eyes. FLUORESCEIN ANGIOGRAPHY: There is staining macular drusen in each eye. In the inferior temporal periphery in the right eye there is subretinal hemorrhage which is hypofluorescence, and in the inferotemporal periphery in the left eye there is a staining disciform scar. IMPRESSION: 1. AGE-RELATED MACULAR DEGENERATION – BOTH EYES 2. ECCENTRIC DISCIFORM SCARS – BOTH EYES 3. BREAKTHROUGH VITREOUS HEMORRHAGE – RIGHT EYE 4. ADVANCED GLAUCOMA DISCUSSION: I explained to the patient the fog in the right eye is from the bleeding inferotemporally from the eccentric disciform scar. That usually absorbs itself, but if it does not, it would be reasonable to consider either treating the scar with cryotherapy and/or considering vitrectomy.

excentricdisc_wihi01.jpg
Eccentric Disciform Scar - Breakthrough Vitreous Hemorrhage - InferoTemporal Subretinal Fibrosis - Ectopic Choroidal Neovascular Membranes612 views88-year-old man has noticed for the last few months the vision in the right eye is foggy, like there is a film in the eye or a haze, His vision is 20/16 in each eye.
Right eye - inferotemporal periphery there is a hemorrhage at the equator at about 7:00 o’clock, which is about 4-disc diameters across and adjacent to that there is scarring.
Left eye - large disciform scar inferotemporally
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excentricdisc_wihi02.jpg
Eccentric Disciform Scar - Breakthrough Vitreous Hemorrhage - InferoTemporal Subretinal Fibrosis - Ectopic Choroidal Neovascular Membranes260 views88-year-old man has noticed for the last few months the vision in the right eye is foggy, like there is a film in the eye or a haze, His vision is 20/16 in each eye.
Right eye - inferotemporal periphery there is a hemorrhage at the equator at about 7:00 o’clock, which is about 4-disc diameters across and adjacent to that there is scarring.
Left eye - large disciform scar inferotemporally
00000
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excentricdisc_wihi03.jpg
Eccentric Disciform Scar - Breakthrough Vitreous Hemorrhage - InferoTemporal Subretinal Fibrosis - Ectopic Choroidal Neovascular Membranes236 views88-year-old man has noticed for the last few months the vision in the right eye is foggy, like there is a film in the eye or a haze, His vision is 20/16 in each eye.
Right eye - inferotemporal periphery there is a hemorrhage at the equator at about 7:00 o’clock, which is about 4-disc diameters across and adjacent to that there is scarring.
Left eye - large disciform scar inferotemporally
00000
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excentricdisc_wihi04.jpg
Eccentric Disciform Scar - Breakthrough Vitreous Hemorrhage - InferoTemporal Subretinal Fibrosis - Ectopic Choroidal Neovascular Membranes224 views88-year-old man has noticed for the last few months the vision in the right eye is foggy, like there is a film in the eye or a haze, His vision is 20/16 in each eye.
Right eye - inferotemporal periphery there is a hemorrhage at the equator at about 7:00 o’clock, which is about 4-disc diameters across and adjacent to that there is scarring.
Left eye - large disciform scar inferotemporally
00000
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excentricdisc_wihi05.jpg
Eccentric Disciform Scar - Breakthrough Vitreous Hemorrhage - InferoTemporal Subretinal Fibrosis - Ectopic Choroidal Neovascular Membranes179 views88-year-old man has noticed for the last few months the vision in the right eye is foggy, like there is a film in the eye or a haze, His vision is 20/16 in each eye.
Right eye - inferotemporal periphery there is a hemorrhage at the equator at about 7:00 o’clock, which is about 4-disc diameters across and adjacent to that there is scarring.
Left eye - large disciform scar inferotemporally
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excentricdisc_wihi06.jpg
Eccentric Disciform Scar - Breakthrough Vitreous Hemorrhage - InferoTemporal Subretinal Fibrosis - Ectopic Choroidal Neovascular Membranes159 views88-year-old man has noticed for the last few months the vision in the right eye is foggy, like there is a film in the eye or a haze, His vision is 20/16 in each eye.
Right eye - inferotemporal periphery there is a hemorrhage at the equator at about 7:00 o’clock, which is about 4-disc diameters across and adjacent to that there is scarring.
Left eye - large disciform scar inferotemporally
00000
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excentricdisc_wihi07.jpg
Eccentric Disciform Scar - Breakthrough Vitreous Hemorrhage - InferoTemporal Subretinal Fibrosis - Ectopic Choroidal Neovascular Membranes136 views88-year-old man has noticed for the last few months the vision in the right eye is foggy, like there is a film in the eye or a haze, His vision is 20/16 in each eye.
Right eye - inferotemporal periphery there is a hemorrhage at the equator at about 7:00 o’clock, which is about 4-disc diameters across and adjacent to that there is scarring.
Left eye - large disciform scar inferotemporally
00000
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excentricdisc_wihi08.jpg
Eccentric Disciform Scar - Breakthrough Vitreous Hemorrhage - InferoTemporal Subretinal Fibrosis - Ectopic Choroidal Neovascular Membranes240 views88-year-old man has noticed for the last few months the vision in the right eye is foggy, like there is a film in the eye or a haze, His vision is 20/16 in each eye.
Right eye - inferotemporal periphery there is a hemorrhage at the equator at about 7:00 o’clock, which is about 4-disc diameters across and adjacent to that there is scarring.
Left eye - large disciform scar inferotemporally
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excentricdisc_wihi09.jpg
Eccentric Disciform Scar - Breakthrough Vitreous Hemorrhage - InferoTemporal Subretinal Fibrosis - Ectopic Choroidal Neovascular Membranes132 views88-year-old man has noticed for the last few months the vision in the right eye is foggy, like there is a film in the eye or a haze, His vision is 20/16 in each eye.
Right eye - inferotemporal periphery there is a hemorrhage at the equator at about 7:00 o’clock, which is about 4-disc diameters across and adjacent to that there is scarring.
Left eye - large disciform scar inferotemporally
00000
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excentricdisc_wihi10.jpg
Eccentric Disciform Scar - Breakthrough Vitreous Hemorrhage - InferoTemporal Subretinal Fibrosis - Ectopic Choroidal Neovascular Membranes138 views88-year-old man has noticed for the last few months the vision in the right eye is foggy, like there is a film in the eye or a haze, His vision is 20/16 in each eye.
Right eye - inferotemporal periphery there is a hemorrhage at the equator at about 7:00 o’clock, which is about 4-disc diameters across and adjacent to that there is scarring.
Left eye - large disciform scar inferotemporally
00000
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excentricdisc_wihi11.jpg
Eccentric Disciform Scar - Breakthrough Vitreous Hemorrhage - InferoTemporal Subretinal Fibrosis - Ectopic Choroidal Neovascular Membranes93 views88-year-old man has noticed for the last few months the vision in the right eye is foggy, like there is a film in the eye or a haze, His vision is 20/16 in each eye.
Right eye - inferotemporal periphery there is a hemorrhage at the equator at about 7:00 o’clock, which is about 4-disc diameters across and adjacent to that there is scarring.
Left eye - large disciform scar inferotemporally
00000
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excentricdisc_wihi12.jpg
Eccentric Disciform Scar - Breakthrough Vitreous Hemorrhage - InferoTemporal Subretinal Fibrosis - Ectopic Choroidal Neovascular Membranes82 views88-year-old man has noticed for the last few months the vision in the right eye is foggy, like there is a film in the eye or a haze, His vision is 20/16 in each eye.
Right eye - inferotemporal periphery there is a hemorrhage at the equator at about 7:00 o’clock, which is about 4-disc diameters across and adjacent to that there is scarring.
Left eye - large disciform scar inferotemporally
00000
(0 votes)
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excentricdisc_wihi13.jpg
Eccentric Disciform Scar - Breakthrough Vitreous Hemorrhage - InferoTemporal Subretinal Fibrosis - Ectopic Choroidal Neovascular Membranes99 views88-year-old man has noticed for the last few months the vision in the right eye is foggy, like there is a film in the eye or a haze, His vision is 20/16 in each eye.
Right eye - inferotemporal periphery there is a hemorrhage at the equator at about 7:00 o’clock, which is about 4-disc diameters across and adjacent to that there is scarring.
Left eye - large disciform scar inferotemporally
00000
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excentricdisc_wihi14.jpg
Eccentric Disciform Scar - Breakthrough Vitreous Hemorrhage - InferoTemporal Subretinal Fibrosis - Ectopic Choroidal Neovascular Membranes85 views88-year-old man has noticed for the last few months the vision in the right eye is foggy, like there is a film in the eye or a haze, His vision is 20/16 in each eye.
Right eye - inferotemporal periphery there is a hemorrhage at the equator at about 7:00 o’clock, which is about 4-disc diameters across and adjacent to that there is scarring.
Left eye - large disciform scar inferotemporally
00000
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excentricdisc_wihi15.jpg
Eccentric Disciform Scar - Breakthrough Vitreous Hemorrhage - InferoTemporal Subretinal Fibrosis - Ectopic Choroidal Neovascular Membranes124 views88-year-old man has noticed for the last few months the vision in the right eye is foggy, like there is a film in the eye or a haze, His vision is 20/16 in each eye.
Right eye - inferotemporal periphery there is a hemorrhage at the equator at about 7:00 o’clock, which is about 4-disc diameters across and adjacent to that there is scarring.
Left eye - large disciform scar inferotemporally
00000
(0 votes)
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excentricdisc_wihi16.jpg
Eccentric Disciform Scar - Breakthrough Vitreous Hemorrhage - InferoTemporal Subretinal Fibrosis - Ectopic Choroidal Neovascular Membranes201 views88-year-old man has noticed for the last few months the vision in the right eye is foggy, like there is a film in the eye or a haze, His vision is 20/16 in each eye.
Right eye - inferotemporal periphery there is a hemorrhage at the equator at about 7:00 o’clock, which is about 4-disc diameters across and adjacent to that there is scarring.
Left eye - large disciform scar inferotemporally
00000
(0 votes)
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excentricdisc_wihi17.jpg
Eccentric Disciform Scar - Breakthrough Vitreous Hemorrhage - InferoTemporal Subretinal Fibrosis - Ectopic Choroidal Neovascular Membranes173 views88-year-old man has noticed for the last few months the vision in the right eye is foggy, like there is a film in the eye or a haze, His vision is 20/16 in each eye.
Right eye - inferotemporal periphery there is a hemorrhage at the equator at about 7:00 o’clock, which is about 4-disc diameters across and adjacent to that there is scarring.
Left eye - large disciform scar inferotemporally
00000
(0 votes)
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excentricdisc_wihi18.jpg
Eccentric Disciform Scar - Breakthrough Vitreous Hemorrhage - InferoTemporal Subretinal Fibrosis - Ectopic Choroidal Neovascular Membranes247 views88-year-old man has noticed for the last few months the vision in the right eye is foggy, like there is a film in the eye or a haze, His vision is 20/16 in each eye.
Right eye - inferotemporal periphery there is a hemorrhage at the equator at about 7:00 o’clock, which is about 4-disc diameters across and adjacent to that there is scarring.
Left eye - large disciform scar inferotemporally
00000
(0 votes)
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88-year-old man was seen in the office on 9/2/2011. He has had glaucoma for several years. He had surgery for that some time ago. He has noticed for the last few months the vision in the right eye is foggy, like there is a film in the eye or a haze, and he does not see well out of the eye. His left eye is also a little bit foggy. He has been diabetic for sixteen years. He stopped his aspirin recently for an ear procedure. VISUAL ACUITY: His vision is 20/16 in each eye. IOP: 13 in both eyes. AMSLER GRID: Normal in both eyes. SLIT LAMP EXAM: There are functioning filtering blebs in both eyes with the posterior chamber intraocular lens in good position in both eyes with open capsules. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.7. The nerve is pale. There are 1+ macular drusen. There is no diabetic retinopathy. In the inferotemporal periphery there is a hemorrhage at the equator at about 7:00 o’clock, which is about 4-disc diameters across and adjacent to that there is scarring. OS: Vertical C/D ratio is 0.7. There is a posterior vitreous separation. There is a fairly extensive disciform scar in the periphery. Inferotemporally there are 1+ macular drusen. OCT SCAN: The OCT scan of the macula is normal in both eyes. FLUORESCEIN ANGIOGRAPHY: There is staining macular drusen in each eye. In the inferior temporal periphery in the right eye there is subretinal hemorrhage which is hypofluorescence, and in the inferotemporal periphery in the left eye there is a staining disciform scar. IMPRESSION: 1. AGE-RELATED MACULAR DEGENERATION – BOTH EYES 2. ECCENTRIC DISCIFORM SCARS – BOTH EYES 3. BREAKTHROUGH VITREOUS HEMORRHAGE – RIGHT EYE 4. ADVANCED GLAUCOMA DISCUSSION: I explained to the patient the fog in the right eye is from the bleeding inferotemporally from the eccentric disciform scar. That usually absorbs itself, but if it does not, it would be reasonable to consider either treating the scar with cryotherapy and/or considering vitrectomy.