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49-year-old man that I saw in the office on December 11, 2008. He had a flu two weeks ago, since Friday which is about six days ago. His right eye has been throbbing and his vision in the right eye has been foggy. He says that he has also had some problems with sinus disease lately and he has allergies and also he is hypothyroid. He recently is undergoing blood tests for possible arthritic syndrome. His hand joints are a little stiff. He has no significant rashes or oral or genital sores. VISUAL ACUITY: OD 20/80, OS 20/40. IOP: 14 OU. SLIT EXAMINATION: There is 1+ nuclear sclerosis in both eyes. There is no uveitis, nor is there any vitritis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.3. There is no posterior vitreous separation. There is 3+ cystoid macular edema. OS: Vertical C/D ration is 0.3. There is no posterior vitreous separation and the macula looks dry. I checked his blood pressure and it was 110/80. OCT SCAN: The OCT scan of the right eye shows cystoid macular edema with a novel increase central foveal thickness to about three times normal. The left eye has a normal foveal contour. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAM: Fluorescein angiogram shows cuticular drusen in both eyes. The right eye does have profuse leakage into the fovea and the late frames. The left eye does have a little bit of leakage temporal to the fovea, neither eye has staining of the optic nerve, suggesting an absence of uveitis. The filling time and recirculation time of the right eye was normal. IMPRESSION: 1. CYSTOID MACULAR EDEMA – RIGHT EYE 2. BLOOD RETINAL BARRIER BREAK DOWN – BOTH EYES 3. POSSIBLE ARTHRITIC SYNDROME 4. SINUS DISEASE DISCUSSION: I explained to the patient that it is unusual to get cystoid macular edema in the absence of any other findings that would suggest a cause for it. He does not have any sign of inflammation in the eye. There is no staining of the optic nerve. There is no vitreous cells in the anterior or posterior vitreous even with eye movement. I am concerned though that the pain in the eye suggests that he may have some sort of low-grade inflammation. Because of the possibility of an infectious sinus disease I suggest that we not use steroids for now. I did ask him to return for a check in a month. I think it is possible that the cystoid macular edema may resolve on its own. If it does not steroid treatment would be appropriate as long as systemic infectious diseases are ruled out prior to the institution of steroids. Follow-up Visit: July 29, 2010. This pleasant 50-year-old man has idiopathic cystoid macular edema in the right eye, which responds to Kenalog injections. He had a posterior sub-Tenon Kenalog injection in January of 2009 and January of 2010. His macula tends to swell to about 400 microns. His vision is hazy in the eye. He is developing a worsening cataract though. VISUAL ACUITY: OD 20/60. IOP: 14. There is 3+ nuclear sclerosis with 2+ posterior subcapsular cataract. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.3. The macula is dry. OCT SCAN: The OCT scan shows an average central foveal thickness of 219 microns. IMPRESSION: 1. RESOLVED IDIOPATHIC CYSTOID MACULAR EDEMA – RIGHT EYE 2. CATARACT DISCUSSION: I explained to the patient the macula is dry, but the cataract is substantially worse. I asked him to discuss that with you and I believe that cataract surgery would be a reasonable option. He should be covered with increased pre and postoperative anti-inflammatory medications around the time of the cataract surgery. It might even be worthwhile considering a prophylactic posterior sub-Tenon Kenalog injection in his eye prior to the surgery, because of his problem with macular edema. I asked him to return here for a check in three to four months. He will be seeing you next month. If you would like to do cataract surgery, which I think is a reasonable to consider, I would appreciate seeing him back prior to that for a Kenalog treatment

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Idiopathic Cystoid Macular Edema - CME - Responded to Subtenons Kenalog - Color Photo Showing Foveal Cysts282 views49-year-old man had a flu two weeks ago the right eye has been throbbing and his vision in the right eye has been foggy. OD 20/80, OS 20/40. IOP: 14 OU.
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(1 votes)
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Idiopathic Cystoid Macular Edema - CME - Responded to Subtenons Kenalog - Color Photo285 views49-year-old man had a flu two weeks ago the right eye has been throbbing and his vision in the right eye has been foggy. OD 20/80, OS 20/40. IOP: 14 OU.
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(0 votes)
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Idiopathic Cystoid Macular Edema - CME - Pre Treatment Optical Coherence Tomography Map Showing Thickened Right Macula325 views49-year-old man had a flu two weeks ago the right eye has been throbbing and his vision in the right eye has been foggy. OD 20/80, OS 20/40. IOP: 14 OU.
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Idiopathic Cystoid Macular Edema - CME - Responded to Subtenons Kenalog - Pre Treatment Line Scan ShowingLarge Foveal Cysts214 views49-year-old man had a flu two weeks ago the right eye has been throbbing and his vision in the right eye has been foggy. OD 20/80, OS 20/40. IOP: 14 OU.
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Idiopathic Cystoid Macular Edema - CME - Responded to Subtenons Kenalog - Red Free Photos Shows Foveal Cysts169 views49-year-old man had a flu two weeks ago the right eye has been throbbing and his vision in the right eye has been foggy. OD 20/80, OS 20/40. IOP: 14 OU.
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Idiopathic Cystoid Macular Edema - CME - Responded to Subtenons Kenalog - Early Fluorescein Angiogram Showing Dilated Capillaries159 views49-year-old man had a flu two weeks ago the right eye has been throbbing and his vision in the right eye has been foggy. OD 20/80, OS 20/40. IOP: 14 OU.
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Idiopathic Cystoid Macular Edema - CME - Responded to Subtenons Kenalog - Early Fluorescein Showing Dilated Capillaries257 views49-year-old man had a flu two weeks ago the right eye has been throbbing and his vision in the right eye has been foggy. OD 20/80, OS 20/40. IOP: 14 OU.
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(0 votes)
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Idiopathic Cystoid Macular Edema - Mid Phase Fluorescein Angiogram Showing Leakage of Dye into Center of Macula372 views49-year-old man had a flu two weeks ago the right eye has been throbbing and his vision in the right eye has been foggy. OD 20/80, OS 20/40. IOP: 14 OU.
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Idiopathic Cystoid Macular Edema - CME - Responded to Subtenons Kenalog - Fluorescein Angiogram - Leakage of White Dye Into Center of Macula313 views49-year-old man had a flu two weeks ago the right eye has been throbbing and his vision in the right eye has been foggy. OD 20/80, OS 20/40. IOP: 14 OU.
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Idiopathic Cystoid Macular Edema - CME - Responded to Subtenons Kenalog - Fellow (uninvolved) Eye Nearly Normal Dark Center FA288 views49-year-old man had a flu two weeks ago the right eye has been throbbing and his vision in the right eye has been foggy. OD 20/80, OS 20/40. IOP: 14 OU.
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Idiopathic Cystoid Macular Edema - CME - Close up of Late Fluorescein Angiogram Showing Leakage into Foveal Cysts353 views49-year-old man had a flu two weeks ago the right eye has been throbbing and his vision in the right eye has been foggy. OD 20/80, OS 20/40. IOP: 14 OU.
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49-year-old man that I saw in the office on December 11, 2008. He had a flu two weeks ago, since Friday which is about six days ago. His right eye has been throbbing and his vision in the right eye has been foggy. He says that he has also had some problems with sinus disease lately and he has allergies and also he is hypothyroid. He recently is undergoing blood tests for possible arthritic syndrome. His hand joints are a little stiff. He has no significant rashes or oral or genital sores. VISUAL ACUITY: OD 20/80, OS 20/40. IOP: 14 OU. SLIT EXAMINATION: There is 1+ nuclear sclerosis in both eyes. There is no uveitis, nor is there any vitritis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.3. There is no posterior vitreous separation. There is 3+ cystoid macular edema. OS: Vertical C/D ration is 0.3. There is no posterior vitreous separation and the macula looks dry. I checked his blood pressure and it was 110/80. OCT SCAN: The OCT scan of the right eye shows cystoid macular edema with a novel increase central foveal thickness to about three times normal. The left eye has a normal foveal contour. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAM: Fluorescein angiogram shows cuticular drusen in both eyes. The right eye does have profuse leakage into the fovea and the late frames. The left eye does have a little bit of leakage temporal to the fovea, neither eye has staining of the optic nerve, suggesting an absence of uveitis. The filling time and recirculation time of the right eye was normal. IMPRESSION: 1. CYSTOID MACULAR EDEMA – RIGHT EYE 2. BLOOD RETINAL BARRIER BREAK DOWN – BOTH EYES 3. POSSIBLE ARTHRITIC SYNDROME 4. SINUS DISEASE DISCUSSION: I explained to the patient that it is unusual to get cystoid macular edema in the absence of any other findings that would suggest a cause for it. He does not have any sign of inflammation in the eye. There is no staining of the optic nerve. There is no vitreous cells in the anterior or posterior vitreous even with eye movement. I am concerned though that the pain in the eye suggests that he may have some sort of low-grade inflammation. Because of the possibility of an infectious sinus disease I suggest that we not use steroids for now. I did ask him to return for a check in a month. I think it is possible that the cystoid macular edema may resolve on its own. If it does not steroid treatment would be appropriate as long as systemic infectious diseases are ruled out prior to the institution of steroids. Follow-up Visit: July 29, 2010. This pleasant 50-year-old man has idiopathic cystoid macular edema in the right eye, which responds to Kenalog injections. He had a posterior sub-Tenon Kenalog injection in January of 2009 and January of 2010. His macula tends to swell to about 400 microns. His vision is hazy in the eye. He is developing a worsening cataract though. VISUAL ACUITY: OD 20/60. IOP: 14. There is 3+ nuclear sclerosis with 2+ posterior subcapsular cataract. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.3. The macula is dry. OCT SCAN: The OCT scan shows an average central foveal thickness of 219 microns. IMPRESSION: 1. RESOLVED IDIOPATHIC CYSTOID MACULAR EDEMA – RIGHT EYE 2. CATARACT DISCUSSION: I explained to the patient the macula is dry, but the cataract is substantially worse. I asked him to discuss that with you and I believe that cataract surgery would be a reasonable option. He should be covered with increased pre and postoperative anti-inflammatory medications around the time of the cataract surgery. It might even be worthwhile considering a prophylactic posterior sub-Tenon Kenalog injection in his eye prior to the surgery, because of his problem with macular edema. I asked him to return here for a check in three to four months. He will be seeing you next month. If you would like to do cataract surgery, which I think is a reasonable to consider, I would appreciate seeing him back prior to that for a Kenalog treatment