CME - Pseudophakic - Migrated Haptic into Anterior Chamber
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57-year-old man was seen in the office on 12/6/2011. He has had poor vision since he was a child. At about age two, he started wearing glasses. He is not sure whether he was farsighted or nearsighted, but he does not think the prescriptions were particularly strong. Even with the glasses, he was not correctable to good vision. He had cataract surgery done in the early 1980s with intraocular lens implants. He noticed the left eye has always been a little worse than the right eye, and after the cataract surgery, both eyes still did not see well. He said when his mother had cataract surgery, her vision was perfect but his vision was never much better than 20/50 or 20/60. Getting his driver’s license has always been a little bit of a struggle. Your records show as recently as January of 2008 the vision was equal at 20/60 in both eyes. He has had decreasing vision for the last several months in the left eye and he is on Pred Forte and Bromfenac for that.
He does have small amplitude nystagmus. He had eye surgery on his left eye about 35 years ago where the muscles were moved to try to decrease the movement in the eye.
He has also had hearing aids since his twenties for poor hearing. He is otherwise in good health.
His mother did have a high fever when she was pregnant with him and there was some thought that that might have affected his vision. He has no relatives with similar eye problems.
VISUAL ACUITY: Vision OD is 20/50, OS is 20/100. IOP: OD 13, OS 18. There is low-amplitude horizontal fairly rapid nystagmus in both eyes.
COLOR VISION: Normal in both eyes.
SLIT LAMP EXAM: The right eye has a posterior chamber intraocular lens is in good position with an open capsule. The left eye has a posterior chamber intraocular lens with a haptic in the angle superiorly, but the lens is centered. He says that as far as he knows, it has been like that for years.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.0. There are 2+ vitreous opacities. The fovea looks to be aplastic and there is lattice degeneration at 12:00 o’clock and 6:00 o’clock.
OS: Vertical C/D ratio is 0.0. There is a posterior vitreous separation with 2+ vitreous opacities. The macula looks irregular and there is lattice degeneration at 12:00 o’clock and 6:00 o’clock.
OCT SCAN: The OCT scan of the right eye shows foveal aplasia. There is not a normal foveal depression, but the retinal thickness is reasonable. The average central foveal thickness is 265 microns. The left eye shows macular edema with an average central foveal thickness of 511 microns.
PHOTOGRAPHS: Photos confirm clinical findings, in addition to a lack of a fovea given the vascular pattern.
FLUORESCEIN ANGIOGRAPHY: The FA shows diffuse leakage from both the retinal vessels and the nerve in the left eye with macular edema and retinal staining in the late frames. The right eye looks angiographically normal except for the absence of the fovea.
IMPRESSION:
1. PSEUDOPHAKIC CYSTOID MACULAR EDEMA – LEFT EYE
2. FOVEAL APLASIA – BOTH EYES
3. CONGENITAL NYSTAGMUS
4. LATTICE DEGENERATION
5. VITREOUS OPACITIES
DISCUSSION: I explained to the patient that the left macula is swollen, probably related to the haptic irritating the eye, although the haptic has been there for awhile and it is possible there might be something else going on, like low-grade uveitis. Either way, the anti-inflammatory drops do not seem to be helping and I suggest we try a posterior sub-Tenon Kenalog injection. His intraocular pressure is a little bit high today and it is possible it would go up further with the steroid shot so I will watch him for that. It is possible his macula may dry and his vision may not improve. It depends a little bit on how long the swelling has been there. If his macula does not dry, then other treatments could be tried. If it does dry and improve, then I will probably forego further treatment.
I asked him to return here in about four weeks, sooner should he notice a problem.
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Chronic Pseudophakic Cystoid Macular Edema - Haptic Migrated into Anterior Chamber Through Peripheral Iridotomy632 views57-year-old man with congenital nystagmus. He had cataract surgery done 30 years ago and has decreased vision left eye for 6 months. OD is 20/50, OS is 20/100
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Chronic Pseudophakic Cystoid Macular Edema - Haptic Migrated into Anterior Chamber Through Peripheral Iridotomy498 views57-year-old man with congenital nystagmus. He had cataract surgery done 30 years ago and has decreased vision left eye for 6 months. OD is 20/50, OS is 20/100
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Chronic Pseudophakic Cystoid Macular Edema - Haptic Migrated into Anterior Chamber Through Peripheral Iridotomy425 views57-year-old man with congenital nystagmus. He had cataract surgery done 30 years ago and has decreased vision left eye for 6 months. OD is 20/50, OS is 20/100
(0 votes)
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Chronic Pseudophakic Cystoid Macular Edema - Haptic Migrated into Anterior Chamber Through Peripheral Iridotomy447 views57-year-old man with congenital nystagmus. He had cataract surgery done 30 years ago and has decreased vision left eye for 6 months. OD is 20/50, OS is 20/100
(0 votes)
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Chronic Pseudophakic Cystoid Macular Edema - Haptic Migrated into Anterior Chamber Through Peripheral Iridotomy420 views57-year-old man with congenital nystagmus. He had cataract surgery done 30 years ago and has decreased vision left eye for 6 months. OD is 20/50, OS is 20/100
(0 votes)
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Chronic Pseudophakic Cystoid Macular Edema - Haptic Migrated into Anterior Chamber Through Peripheral Iridotomy351 views57-year-old man with congenital nystagmus. He had cataract surgery done 30 years ago and has decreased vision left eye for 6 months. OD is 20/50, OS is 20/100
(0 votes)
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Chronic Pseudophakic Cystoid Macular Edema - Haptic Migrated into Anterior Chamber Through Peripheral Iridotomy413 views57-year-old man with congenital nystagmus. He had cataract surgery done 30 years ago and has decreased vision left eye for 6 months. OD is 20/50, OS is 20/100
(0 votes)
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Chronic Pseudophakic Cystoid Macular Edema - Haptic Migrated into Anterior Chamber Through Peripheral Iridotomy394 views57-year-old man with congenital nystagmus. He had cataract surgery done 30 years ago and has decreased vision left eye for 6 months. OD is 20/50, OS is 20/100
(0 votes)
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Chronic Pseudophakic Cystoid Macular Edema - Haptic Migrated into Anterior Chamber Through Peripheral Iridotomy329 views57-year-old man with congenital nystagmus. He had cataract surgery done 30 years ago and has decreased vision left eye for 6 months. OD is 20/50, OS is 20/100
(0 votes)
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Chronic Pseudophakic Cystoid Macular Edema - Haptic Migrated into Anterior Chamber Through Peripheral Iridotomy406 views57-year-old man with congenital nystagmus. He had cataract surgery done 30 years ago and has decreased vision left eye for 6 months. OD is 20/50, OS is 20/100
(0 votes)
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Chronic Pseudophakic Cystoid Macular Edema - Haptic Migrated into Anterior Chamber Through Peripheral Iridotomy387 views57-year-old man with congenital nystagmus. He had cataract surgery done 30 years ago and has decreased vision left eye for 6 months. OD is 20/50, OS is 20/100
(0 votes)
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Chronic Pseudophakic Cystoid Macular Edema - Haptic Migrated into Anterior Chamber Through Peripheral Iridotomy441 views57-year-old man with congenital nystagmus. He had cataract surgery done 30 years ago and has decreased vision left eye for 6 months. OD is 20/50, OS is 20/100
(0 votes)
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Chronic Pseudophakic Cystoid Macular Edema - Haptic Migrated into Anterior Chamber Through Peripheral Iridotomy511 views57-year-old man with congenital nystagmus. He had cataract surgery done 30 years ago and has decreased vision left eye for 6 months. OD is 20/50, OS is 20/100
(0 votes)
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Chronic Pseudophakic Cystoid Macular Edema - Haptic Migrated into Anterior Chamber Through Peripheral Iridotomy424 views57-year-old man with congenital nystagmus. He had cataract surgery done 30 years ago and has decreased vision left eye for 6 months. OD is 20/50, OS is 20/100
(0 votes)
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Chronic Pseudophakic Cystoid Macular Edema - Haptic Migrated into Anterior Chamber Through Peripheral Iridotomy488 views57-year-old man with congenital nystagmus. He had cataract surgery done 30 years ago and has decreased vision left eye for 6 months. OD is 20/50, OS is 20/100
(0 votes)
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57-year-old man was seen in the office on 12/6/2011. He has had poor vision since he was a child. At about age two, he started wearing glasses. He is not sure whether he was farsighted or nearsighted, but he does not think the prescriptions were particularly strong. Even with the glasses, he was not correctable to good vision. He had cataract surgery done in the early 1980s with intraocular lens implants. He noticed the left eye has always been a little worse than the right eye, and after the cataract surgery, both eyes still did not see well. He said when his mother had cataract surgery, her vision was perfect but his vision was never much better than 20/50 or 20/60. Getting his driver’s license has always been a little bit of a struggle. Your records show as recently as January of 2008 the vision was equal at 20/60 in both eyes. He has had decreasing vision for the last several months in the left eye and he is on Pred Forte and Bromfenac for that.
He does have small amplitude nystagmus. He had eye surgery on his left eye about 35 years ago where the muscles were moved to try to decrease the movement in the eye.
He has also had hearing aids since his twenties for poor hearing. He is otherwise in good health.
His mother did have a high fever when she was pregnant with him and there was some thought that that might have affected his vision. He has no relatives with similar eye problems.
VISUAL ACUITY: Vision OD is 20/50, OS is 20/100. IOP: OD 13, OS 18. There is low-amplitude horizontal fairly rapid nystagmus in both eyes.
COLOR VISION: Normal in both eyes.
SLIT LAMP EXAM: The right eye has a posterior chamber intraocular lens is in good position with an open capsule. The left eye has a posterior chamber intraocular lens with a haptic in the angle superiorly, but the lens is centered. He says that as far as he knows, it has been like that for years.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.0. There are 2+ vitreous opacities. The fovea looks to be aplastic and there is lattice degeneration at 12:00 o’clock and 6:00 o’clock.
OS: Vertical C/D ratio is 0.0. There is a posterior vitreous separation with 2+ vitreous opacities. The macula looks irregular and there is lattice degeneration at 12:00 o’clock and 6:00 o’clock.
OCT SCAN: The OCT scan of the right eye shows foveal aplasia. There is not a normal foveal depression, but the retinal thickness is reasonable. The average central foveal thickness is 265 microns. The left eye shows macular edema with an average central foveal thickness of 511 microns.
PHOTOGRAPHS: Photos confirm clinical findings, in addition to a lack of a fovea given the vascular pattern.
FLUORESCEIN ANGIOGRAPHY: The FA shows diffuse leakage from both the retinal vessels and the nerve in the left eye with macular edema and retinal staining in the late frames. The right eye looks angiographically normal except for the absence of the fovea.
IMPRESSION:
1. PSEUDOPHAKIC CYSTOID MACULAR EDEMA – LEFT EYE
2. FOVEAL APLASIA – BOTH EYES
3. CONGENITAL NYSTAGMUS
4. LATTICE DEGENERATION
5. VITREOUS OPACITIES
DISCUSSION: I explained to the patient that the left macula is swollen, probably related to the haptic irritating the eye, although the haptic has been there for awhile and it is possible there might be something else going on, like low-grade uveitis. Either way, the anti-inflammatory drops do not seem to be helping and I suggest we try a posterior sub-Tenon Kenalog injection. His intraocular pressure is a little bit high today and it is possible it would go up further with the steroid shot so I will watch him for that. It is possible his macula may dry and his vision may not improve. It depends a little bit on how long the swelling has been there. If his macula does not dry, then other treatments could be tried. If it does dry and improve, then I will probably forego further treatment.
I asked him to return here in about four weeks, sooner should he notice a problem.
