Ectopic Active Choroidal Neovascular Membrane - Reactive Inflammation and Macular Edema
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53-year-old woman was seen in the office on 6/24/2011. Also, thank you for your detailed letter which was helpful. She has noticed some blurred vision in the right eye. It sounds like it has been going on for a few years. In retrospect, she thinks it is possible since she was a teenager the right eye was always the weaker eye and that the left eye has always been the better eye. You have been treating her recently with Pred Forte in the right eye and she does notice her vision improving over the last several weeks.
VISUAL ACUITY: Vision OD is 20/400, PH 20/120; OS 20/60, PH 20/40. IOP: OD 18, OS 22.
SLIT LAMP EXAM: There is 1+ nuclear sclerosis in both eyes. The anterior chamber in the right eye does have 1+ cell but that is with dilation drops.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. There is a posterior vitreous separation. There are 2-3+ vitreous cells, mostly on the posterior surface of the vitreous gel. The macula looks irregular. Inferotemporally there is retinal vascular irregularities and there is subretinal exudate and fluid, all consistent with, as you noted, an ectopic disciform scar.
OS: Vertical C/D ratio is 0.5. There is no posterior vitreous separation. There is 1+ epiretinal membrane.
OCT SCAN: The OCT scan of the right eye shows intraretinal cysts centrally with a central foveal thickness of 369 microns. The left eye has an epiretinal membrane with a central foveal thickness of 249 microns.
PHOTOGRAPHS: Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: The right eye shows staining of the optic nerve and the macula in the late frames in a cystoid pattern. There is leakage around the exudative lesion inferotemporally. The left eye angiogram is nearly normal.
IMPRESSION:
1. ECTOPIC DISCIFORM SCAR/PERIPHERAL CHOROIDAL NEOVASCULAR MEMBRANE – RIGHT EYE
2. EXUDATE – RIGHT EYE
3. INFLAMMATION IN REACTION TO THE PERIPHERAL VASCULAR LESION – RIGHT EYE
4. INFLAMMATORY CYSTOID MACULAR EDEMA – RIGHT EYE
5. MACULAR PUCKER WITH VITREOMACULAR TRACTION – LEFT EYE
6. CATARACT
7. POSSIBLE AMBLYOPIA – RIGHT EYE
DISCUSSION: I explained to the patient the macula in the right eye is swollen and I think as the swelling subsides, her vision will continue to improve. I asked her to continue the anti-inflammatory drops. She will be seeing you back in the near future. If the anti-inflammatory drops do not cause further vision improvement, a posterior sub-Tenon Kenalog injection would be reasonable. Sometimes peripheral vascular lesions can cause inflammation in the eye and ablating them can help and it may be reasonable to consider cryotherapy to that peripheral lesion. To settle it down, it would probably take several courses of therapy over the course of a year or two to get it totally quiet, but that might ultimately preserve the vision and obviate the need for anti-inflammatory medications. The left eye does have vitreomacular traction with a mild epiretinal membrane, but I suspect probably prescription glasses would substantially improve her visual function.
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ECTOPIC DISCIFORM SCAR/PERIPHERAL CHOROIDAL NEOVASCULAR MEMBRANE – EXUDATE –INFLAMMATION IN REACTION TO THE PERIPHERAL VASCULAR LESION 658 views53-year-old woman has noticed some blurred vision in the right eye for a few years. In retrospect, she thinks it is possible since she was a teenager the right eye was always the weaker eye and that the left eye has always been the better eye. VISUAL ACUITY: Vision OD is 20/400
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ECTOPIC DISCIFORM SCAR/PERIPHERAL CHOROIDAL NEOVASCULAR MEMBRANE – EXUDATE –INFLAMMATION IN REACTION TO THE PERIPHERAL VASCULAR LESION 674 views53-year-old woman has noticed some blurred vision in the right eye for a few years. In retrospect, she thinks it is possible since she was a teenager the right eye was always the weaker eye and that the left eye has always been the better eye. VISUAL ACUITY: Vision OD is 20/400
(0 votes)
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ECTOPIC DISCIFORM SCAR/PERIPHERAL CHOROIDAL NEOVASCULAR MEMBRANE – EXUDATE –INFLAMMATION IN REACTION TO THE PERIPHERAL VASCULAR LESION 679 views53-year-old woman has noticed some blurred vision in the right eye for a few years. In retrospect, she thinks it is possible since she was a teenager the right eye was always the weaker eye and that the left eye has always been the better eye. VISUAL ACUITY: Vision OD is 20/400
(0 votes)
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ECTOPIC DISCIFORM SCAR/PERIPHERAL CHOROIDAL NEOVASCULAR MEMBRANE – EXUDATE –INFLAMMATION IN REACTION TO THE PERIPHERAL VASCULAR LESION 656 views53-year-old woman has noticed some blurred vision in the right eye for a few years. In retrospect, she thinks it is possible since she was a teenager the right eye was always the weaker eye and that the left eye has always been the better eye. VISUAL ACUITY: Vision OD is 20/400
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ECTOPIC DISCIFORM SCAR/PERIPHERAL CHOROIDAL NEOVASCULAR MEMBRANE – EXUDATE –INFLAMMATION IN REACTION TO THE PERIPHERAL VASCULAR LESION 492 views53-year-old woman has noticed some blurred vision in the right eye for a few years. In retrospect, she thinks it is possible since she was a teenager the right eye was always the weaker eye and that the left eye has always been the better eye. VISUAL ACUITY: Vision OD is 20/400
(0 votes)
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ECTOPIC DISCIFORM SCAR/PERIPHERAL CHOROIDAL NEOVASCULAR MEMBRANE – EXUDATE –INFLAMMATION IN REACTION TO THE PERIPHERAL VASCULAR LESION 453 views53-year-old woman has noticed some blurred vision in the right eye for a few years. In retrospect, she thinks it is possible since she was a teenager the right eye was always the weaker eye and that the left eye has always been the better eye. VISUAL ACUITY: Vision OD is 20/400
(0 votes)
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ECTOPIC DISCIFORM SCAR/PERIPHERAL CHOROIDAL NEOVASCULAR MEMBRANE – EXUDATE –INFLAMMATION IN REACTION TO THE PERIPHERAL VASCULAR LESION 490 views53-year-old woman has noticed some blurred vision in the right eye for a few years. In retrospect, she thinks it is possible since she was a teenager the right eye was always the weaker eye and that the left eye has always been the better eye. VISUAL ACUITY: Vision OD is 20/400
(0 votes)
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ECTOPIC DISCIFORM SCAR/PERIPHERAL CHOROIDAL NEOVASCULAR MEMBRANE – EXUDATE –INFLAMMATION IN REACTION TO THE PERIPHERAL VASCULAR LESION 461 views53-year-old woman has noticed some blurred vision in the right eye for a few years. In retrospect, she thinks it is possible since she was a teenager the right eye was always the weaker eye and that the left eye has always been the better eye. VISUAL ACUITY: Vision OD is 20/400
(0 votes)
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ECTOPIC DISCIFORM SCAR/PERIPHERAL CHOROIDAL NEOVASCULAR MEMBRANE – EXUDATE –INFLAMMATION IN REACTION TO THE PERIPHERAL VASCULAR LESION 427 views53-year-old woman has noticed some blurred vision in the right eye for a few years. In retrospect, she thinks it is possible since she was a teenager the right eye was always the weaker eye and that the left eye has always been the better eye. VISUAL ACUITY: Vision OD is 20/400
(0 votes)
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ECTOPIC DISCIFORM SCAR/PERIPHERAL CHOROIDAL NEOVASCULAR MEMBRANE – EXUDATE –INFLAMMATION IN REACTION TO THE PERIPHERAL VASCULAR LESION 550 views53-year-old woman has noticed some blurred vision in the right eye for a few years. In retrospect, she thinks it is possible since she was a teenager the right eye was always the weaker eye and that the left eye has always been the better eye. VISUAL ACUITY: Vision OD is 20/400
(0 votes)
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ECTOPIC DISCIFORM SCAR/PERIPHERAL CHOROIDAL NEOVASCULAR MEMBRANE – EXUDATE –INFLAMMATION IN REACTION TO THE PERIPHERAL VASCULAR LESION 506 views53-year-old woman has noticed some blurred vision in the right eye for a few years. In retrospect, she thinks it is possible since she was a teenager the right eye was always the weaker eye and that the left eye has always been the better eye. VISUAL ACUITY: Vision OD is 20/400
(0 votes)
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ECTOPIC DISCIFORM SCAR/PERIPHERAL CHOROIDAL NEOVASCULAR MEMBRANE – EXUDATE –INFLAMMATION IN REACTION TO THE PERIPHERAL VASCULAR LESION 533 views53-year-old woman has noticed some blurred vision in the right eye for a few years. In retrospect, she thinks it is possible since she was a teenager the right eye was always the weaker eye and that the left eye has always been the better eye. VISUAL ACUITY: Vision OD is 20/400
(0 votes)
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ECTOPIC DISCIFORM SCAR/PERIPHERAL CHOROIDAL NEOVASCULAR MEMBRANE – EXUDATE –INFLAMMATION IN REACTION TO THE PERIPHERAL VASCULAR LESION 527 views53-year-old woman has noticed some blurred vision in the right eye for a few years. In retrospect, she thinks it is possible since she was a teenager the right eye was always the weaker eye and that the left eye has always been the better eye. VISUAL ACUITY: Vision OD is 20/400
(0 votes)
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ECTOPIC DISCIFORM SCAR/PERIPHERAL CHOROIDAL NEOVASCULAR MEMBRANE – EXUDATE –INFLAMMATION IN REACTION TO THE PERIPHERAL VASCULAR LESION 549 views53-year-old woman has noticed some blurred vision in the right eye for a few years. In retrospect, she thinks it is possible since she was a teenager the right eye was always the weaker eye and that the left eye has always been the better eye. VISUAL ACUITY: Vision OD is 20/400
(0 votes)
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ECTOPIC DISCIFORM SCAR/PERIPHERAL CHOROIDAL NEOVASCULAR MEMBRANE – EXUDATE –INFLAMMATION IN REACTION TO THE PERIPHERAL VASCULAR LESION 546 views53-year-old woman has noticed some blurred vision in the right eye for a few years. In retrospect, she thinks it is possible since she was a teenager the right eye was always the weaker eye and that the left eye has always been the better eye. VISUAL ACUITY: Vision OD is 20/400
(0 votes)
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53-year-old woman was seen in the office on 6/24/2011. Also, thank you for your detailed letter which was helpful. She has noticed some blurred vision in the right eye. It sounds like it has been going on for a few years. In retrospect, she thinks it is possible since she was a teenager the right eye was always the weaker eye and that the left eye has always been the better eye. You have been treating her recently with Pred Forte in the right eye and she does notice her vision improving over the last several weeks.
VISUAL ACUITY: Vision OD is 20/400, PH 20/120; OS 20/60, PH 20/40. IOP: OD 18, OS 22.
SLIT LAMP EXAM: There is 1+ nuclear sclerosis in both eyes. The anterior chamber in the right eye does have 1+ cell but that is with dilation drops.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. There is a posterior vitreous separation. There are 2-3+ vitreous cells, mostly on the posterior surface of the vitreous gel. The macula looks irregular. Inferotemporally there is retinal vascular irregularities and there is subretinal exudate and fluid, all consistent with, as you noted, an ectopic disciform scar.
OS: Vertical C/D ratio is 0.5. There is no posterior vitreous separation. There is 1+ epiretinal membrane.
OCT SCAN: The OCT scan of the right eye shows intraretinal cysts centrally with a central foveal thickness of 369 microns. The left eye has an epiretinal membrane with a central foveal thickness of 249 microns.
PHOTOGRAPHS: Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: The right eye shows staining of the optic nerve and the macula in the late frames in a cystoid pattern. There is leakage around the exudative lesion inferotemporally. The left eye angiogram is nearly normal.
IMPRESSION:
1. ECTOPIC DISCIFORM SCAR/PERIPHERAL CHOROIDAL NEOVASCULAR MEMBRANE – RIGHT EYE
2. EXUDATE – RIGHT EYE
3. INFLAMMATION IN REACTION TO THE PERIPHERAL VASCULAR LESION – RIGHT EYE
4. INFLAMMATORY CYSTOID MACULAR EDEMA – RIGHT EYE
5. MACULAR PUCKER WITH VITREOMACULAR TRACTION – LEFT EYE
6. CATARACT
7. POSSIBLE AMBLYOPIA – RIGHT EYE
DISCUSSION: I explained to the patient the macula in the right eye is swollen and I think as the swelling subsides, her vision will continue to improve. I asked her to continue the anti-inflammatory drops. She will be seeing you back in the near future. If the anti-inflammatory drops do not cause further vision improvement, a posterior sub-Tenon Kenalog injection would be reasonable. Sometimes peripheral vascular lesions can cause inflammation in the eye and ablating them can help and it may be reasonable to consider cryotherapy to that peripheral lesion. To settle it down, it would probably take several courses of therapy over the course of a year or two to get it totally quiet, but that might ultimately preserve the vision and obviate the need for anti-inflammatory medications. The left eye does have vitreomacular traction with a mild epiretinal membrane, but I suspect probably prescription glasses would substantially improve her visual function.
