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85-year-old man was seen in the office on 8/26/08. He has had difficulty seeing out of his left eye recently. He was in for a scheduled examination with you, a four-month recall check, and it was noted there was a problem in the left eye. He does have mitral valve prolapse, for which he takes blood thinner, but he has a big valve so he is not on Coumadin. He notices the vision in that eye is not normal, especially when he is swimming. With both eyes open, he does okay because his right eye is still fine. Previous to this episode in the left eye, as far as he can recall, the vision in that eye was possibly even a little better than the vision in the right eye. VISUAL ACUITY: Vision OD is 20/25, OS is 20/100. IOP: OD 21, OS 22. SLIT LAMP EXAM: The posterior chamber intraocular lens is in good position in both eyes. The right eye has a small open capsulotomy with a dense fibrous capsule. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There is a posterior vitreous separation and 1+ macular drusen. OS: Vertical C/D ratio is 0.1. There is a posterior vitreous separation. There is a hemorrhagic pigment epithelial detachment on the superior pole of the optic nerve, extending a disc-and-a-half diameter off the nerve, with adjacent exudates. There is a serous macular detachment involving the center of the fovea. OCT SCAN: The right eye is normal. The left eye shows a serous macular detachment. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: FA of the right eye shows staining drusen. The left eye shows a leaky, partially obscured by hemorrhage, choroidal neovascular membrane on the superior pole of the optic nerve with leaky fluid into the subretinal space in the late frames involving the fovea. IMPRESSION: 1. AGE-RELATED MACULAR DEGENERATION – BOTH EYES 2. JUXTAPAPILLARY CHOROIDAL NEOVASCULAR MEMBRANE – LEFT EYE 3. SEROUS MACULAR DETACHMENT – LEFT EYE DISCUSSION: I explained to the patient, given he has a symptomatic juxtapapillary choroidal neovascular membrane in the left eye, choroidal laser has an excellent chance of drying up the retina, reducing the subretinal fluid, and substantially improving his vision. The office visit included a 15-minute counseling session during which I reviewed the alternatives, risks, benefits and limitations of various treatment options. I treated the eye with choroidal laser today. I used the red laser because of the blood and also so I could avoid nerve fiber layer damage. I treated him relatively light for a choroidal neovascular membrane in hopes of drying up the membrane without causing retinal damage. It is possible he may need further treatment if the edges of the lesion show activity after the blood starts to reabsorb. VA improved from 20/100 to 20/50 in four months from laser.

JPCNVMPRELASER_61421.jpg
Juxtapapillary CNVM and Serous Macular Detachment Wet AMD Rx Laser209 views85-year-old man OD is 20/25, OS is 20/100. IOP: OD 21, OS 22.

OS: Vertical C/D ratio is 0.1. There is a posterior vitreous separation. There is a hemorrhagic pigment epithelial detachment on the superior pole of the optic nerve, extending a disc-and-a-half diameter off the nerve, with adjacent exudates. There is a serous macular detachment involving the center of the fovea.

VA improved from 20/100 to 20/50 in four months from laser.
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Juxtapapillary CNVM and Serous Macular Detachment Wet AMD Rx Laser116 views85-year-old man OD is 20/25, OS is 20/100. IOP: OD 21, OS 22.

OS: Vertical C/D ratio is 0.1. There is a posterior vitreous separation. There is a hemorrhagic pigment epithelial detachment on the superior pole of the optic nerve, extending a disc-and-a-half diameter off the nerve, with adjacent exudates. There is a serous macular detachment involving the center of the fovea.

VA improved from 20/100 to 20/50 in four months from laser.
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Juxtapapillary CNVM and Serous Macular Detachment Wet AMD Rx Laser104 views85-year-old man OD is 20/25, OS is 20/100. IOP: OD 21, OS 22.

OS: Vertical C/D ratio is 0.1. There is a posterior vitreous separation. There is a hemorrhagic pigment epithelial detachment on the superior pole of the optic nerve, extending a disc-and-a-half diameter off the nerve, with adjacent exudates. There is a serous macular detachment involving the center of the fovea.

VA improved from 20/100 to 20/50 in four months from laser.
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JPCNVMPRELASER_61421_28129.jpg
Juxtapapillary CNVM and Serous Macular Detachment Wet AMD Rx Laser121 views85-year-old man OD is 20/25, OS is 20/100. IOP: OD 21, OS 22.

OS: Vertical C/D ratio is 0.1. There is a posterior vitreous separation. There is a hemorrhagic pigment epithelial detachment on the superior pole of the optic nerve, extending a disc-and-a-half diameter off the nerve, with adjacent exudates. There is a serous macular detachment involving the center of the fovea.

VA improved from 20/100 to 20/50 in four months from laser.
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JPCNVMPRELASER_61421_28229.jpg
Juxtapapillary CNVM and Serous Macular Detachment Wet AMD Rx Laser140 views85-year-old man OD is 20/25, OS is 20/100. IOP: OD 21, OS 22.

OS: Vertical C/D ratio is 0.1. There is a posterior vitreous separation. There is a hemorrhagic pigment epithelial detachment on the superior pole of the optic nerve, extending a disc-and-a-half diameter off the nerve, with adjacent exudates. There is a serous macular detachment involving the center of the fovea.

VA improved from 20/100 to 20/50 in four months from laser.
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JPCNVMPRELASER_61421_28329.jpg
Juxtapapillary CNVM and Serous Macular Detachment Wet AMD Rx Laser97 views85-year-old man OD is 20/25, OS is 20/100. IOP: OD 21, OS 22.

OS: Vertical C/D ratio is 0.1. There is a posterior vitreous separation. There is a hemorrhagic pigment epithelial detachment on the superior pole of the optic nerve, extending a disc-and-a-half diameter off the nerve, with adjacent exudates. There is a serous macular detachment involving the center of the fovea.

VA improved from 20/100 to 20/50 in four months from laser.
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JPCNVMPRELASER_61421_28429.jpg
Juxtapapillary CNVM and Serous Macular Detachment Wet AMD Rx Laser81 views85-year-old man OD is 20/25, OS is 20/100. IOP: OD 21, OS 22.

OS: Vertical C/D ratio is 0.1. There is a posterior vitreous separation. There is a hemorrhagic pigment epithelial detachment on the superior pole of the optic nerve, extending a disc-and-a-half diameter off the nerve, with adjacent exudates. There is a serous macular detachment involving the center of the fovea.

VA improved from 20/100 to 20/50 in four months from laser.
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JPCNVMpostlaser_61421.jpg
Juxtapapillary CNVM and Serous Macular Detachment Wet AMD Rx Laser129 views85-year-old man OD is 20/25, OS is 20/100. IOP: OD 21, OS 22.

OS: Vertical C/D ratio is 0.1. There is a posterior vitreous separation. There is a hemorrhagic pigment epithelial detachment on the superior pole of the optic nerve, extending a disc-and-a-half diameter off the nerve, with adjacent exudates. There is a serous macular detachment involving the center of the fovea.

VA improved from 20/100 to 20/50 in four months from laser.
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postlaser.jpg
Juxtapapillary CNVM and Serous Macular Detachment Wet AMD Rx Laser85 views85-year-old man OD is 20/25, OS is 20/100. IOP: OD 21, OS 22.

OS: Vertical C/D ratio is 0.1. There is a posterior vitreous separation. There is a hemorrhagic pigment epithelial detachment on the superior pole of the optic nerve, extending a disc-and-a-half diameter off the nerve, with adjacent exudates. There is a serous macular detachment involving the center of the fovea.

VA improved from 20/100 to 20/50 in four months from laser.
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postlaserline.jpg
Juxtapapillary CNVM and Serous Macular Detachment Wet AMD Rx Laser120 views85-year-old man OD is 20/25, OS is 20/100. IOP: OD 21, OS 22.

OS: Vertical C/D ratio is 0.1. There is a posterior vitreous separation. There is a hemorrhagic pigment epithelial detachment on the superior pole of the optic nerve, extending a disc-and-a-half diameter off the nerve, with adjacent exudates. There is a serous macular detachment involving the center of the fovea.

VA improved from 20/100 to 20/50 in four months from laser.
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85-year-old man was seen in the office on 8/26/08. He has had difficulty seeing out of his left eye recently. He was in for a scheduled examination with you, a four-month recall check, and it was noted there was a problem in the left eye. He does have mitral valve prolapse, for which he takes blood thinner, but he has a big valve so he is not on Coumadin. He notices the vision in that eye is not normal, especially when he is swimming. With both eyes open, he does okay because his right eye is still fine. Previous to this episode in the left eye, as far as he can recall, the vision in that eye was possibly even a little better than the vision in the right eye. VISUAL ACUITY: Vision OD is 20/25, OS is 20/100. IOP: OD 21, OS 22. SLIT LAMP EXAM: The posterior chamber intraocular lens is in good position in both eyes. The right eye has a small open capsulotomy with a dense fibrous capsule. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There is a posterior vitreous separation and 1+ macular drusen. OS: Vertical C/D ratio is 0.1. There is a posterior vitreous separation. There is a hemorrhagic pigment epithelial detachment on the superior pole of the optic nerve, extending a disc-and-a-half diameter off the nerve, with adjacent exudates. There is a serous macular detachment involving the center of the fovea. OCT SCAN: The right eye is normal. The left eye shows a serous macular detachment. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: FA of the right eye shows staining drusen. The left eye shows a leaky, partially obscured by hemorrhage, choroidal neovascular membrane on the superior pole of the optic nerve with leaky fluid into the subretinal space in the late frames involving the fovea. IMPRESSION: 1. AGE-RELATED MACULAR DEGENERATION – BOTH EYES 2. JUXTAPAPILLARY CHOROIDAL NEOVASCULAR MEMBRANE – LEFT EYE 3. SEROUS MACULAR DETACHMENT – LEFT EYE DISCUSSION: I explained to the patient, given he has a symptomatic juxtapapillary choroidal neovascular membrane in the left eye, choroidal laser has an excellent chance of drying up the retina, reducing the subretinal fluid, and substantially improving his vision. The office visit included a 15-minute counseling session during which I reviewed the alternatives, risks, benefits and limitations of various treatment options. I treated the eye with choroidal laser today. I used the red laser because of the blood and also so I could avoid nerve fiber layer damage. I treated him relatively light for a choroidal neovascular membrane in hopes of drying up the membrane without causing retinal damage. It is possible he may need further treatment if the edges of the lesion show activity after the blood starts to reabsorb. VA improved from 20/100 to 20/50 in four months from laser.