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34-year-old woman was seen in the office on 8/7/2012. She has noticed a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She thought it would get better, but then it did not. She comes in for an evaluation, noticing, if anything, the vision might be getting a little bit worse. The vision in the left eye is fine. She does have a history of aches and pains and she was diagnosed with Sjogren’s after a series of blood tests were done about a year ago, and she does have intermittent problems. In May she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. Her prescription is about -5.5 in both eyes. She takes Restasis for her dry eye. She is also at the moment working on an infertility workup. She is probably going to try in vitro fertilization. Her last menstrual period was about three weeks ago. She also did start Plaquenil for her Sjogren’s syndrome and she did have a brief course of steroid treatment done about a month ago. She had an injection of steroids and then a brief course of oral steroids for about a week, but that is not uncommon for her and she has not had vision problems with that treatment in the past. VISUAL ACUITY: OD 20/25, OS 20/20. IOP: OD 21, OS 18. SLIT LAMP EXAM: The eye is normal with clear lenses. There are no cells in the anterior chamber. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is no posterior vitreous separation. The anterior vitreous is clear of cells. There are some white spots in the posterior pole around the macula and around the optic nerve. There is no optic nerve swelling nor is there any retinal vasculitis or retinitis. There is a small hemorrhage just inferior to the fovea. OS: The left eye similarly has a few spots in the macula just inferior to the fovea and one superotemporal to the fovea. FLUORESCEIN ANGIOGRAPHY: The right eye shows multiple hypofluorescent spots scattered throughout the posterior pole, many of them being about 200 microns in diameter. Then just inferior and nasal to the fovea, about 1000 microns outside the edge of the foveal avascular zone, there is a subretinal neovascular complex almost exactly a disc area in size. In the left eye, there are some patchy hyperfluorescent spots and hypofluorescent spots scattered throughout the posterior pole, more than are visible on the color pictures. In the late frames, the neovascular complex inferonasal to the optic nerve in the right eye does leak and the dark spots, which are hypofluorescent early, do become hyperfluorescent in the late images. SPECTRALIS-SD-OCT SCAN: The OCT scan of the macula in the right eye does show pigment epithelium thickening, predominately inferior to the fovea where the neovascular complex is with some retinal edema there and subretinal fluid centrally. There is also excrescences off of the pigment epithelium where the white spots are, many of which are under the subretinal fluid, but there is some away from it as well. These appear to indent the small spots which are tiny, roughly 150 microns across, do appear to displace all the layers of the retina, including the external limiting membrane and the other outer lines of the retina and appear to be internal to the basement membrane of the choriocapillaris. It doesn’t appear like there is any choroidal involvement on the OCT scan. The scan of the left eye similarly shows no intraretinal or subretinal fluid. There are however, the deposits which appear to be deep pigment epithelium, but superficial to the basement membrane of the choriocapillaris putting them somewhere in the middle of Bruch’s membrane. FUNDUS PHOTOGRAPHY - AUTO FLUORESCENCE: We did some high definition scans of the spots, which similarly show the location to be away from the choroid and we did auto fluorescence images, which show in the right eye hyper auto fluorescence in the area of the retinal detachment. The white spots only have minimal hypo auto fluorescence. The left eye similarly has a few hypo auto fluorescence spots, but there is a spot superotemporal to the fovea, which is hyper auto fluorescencent. INDOCYANINE GREEN ANGIOGRAPHY: The indocyanine green angiogram shows multiple hypofluorescencent spots, many more than are visible on the fluorescein angiogram. Similarly, the left eye shows hypofluorescence early with hyperfluorescence corresponding to the spots and on indocyanine green angiography they are all hypofluorescencent. IMPRESSION: 1. PUNCTATE INNER CHOROIDOPATHY – BOTH EYES 2. SUBFOVEAL CHOROIDAL NEOVASCULAR MEMBRANE - RIGHT EYE 3. SEROUS MACULAR DETACHMENT – RIGHT EYE 4. POSSIBLE FAMILIAR SYNDROME WITH MOTHER HAVING A SIMILAR PROBLEM AT A RELATIVELY YOUNG AGE DISCUSSION: I explained to the patient with intravitreal Avastin there is an excellent chance of drying the neovascular complex in the right eye and there is a recent study out of Asia showing prospectively in over ten patients, that most patients only need a few treatments in this particular syndrome to quiet the eye and with a one year follow-up. I asked her to return for a check in one month.

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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - Color Fundus Photograph664 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - Color Fundus Photograph408 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - Color Fundus Photograph250 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - Color Fundus Photograph242 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - Color Fundus Photograph326 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - Color Fundus Photograph223 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - Color Fundus Photograph252 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - Color Fundus Photograph307 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - Color Fundus Photograph145 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - Fundus Autofluorescence212 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - Fundus Autofluorescence187 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - InfraRed Photo203 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - InfraRed Photo143 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - Fluorescein Angiogram145 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - Fluorescein Angiogram177 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - Fluorescein Angiogram168 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - Fluorescein Angiogram204 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - Fluorescein Angiogram164 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - Fluorescein Angiogram195 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - Fluorescein Angiogram167 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - Fluorescein Angiogram245 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - Fluorescein Angiogram185 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - Fluorescein Angiogram282 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - Fluorescein Angiogram204 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - Fluorescein Angiogram246 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - ICG Angiogram222 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - ICG Angiogram206 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - ICG Angiogram376 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - ICG Angiogram278 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - ICG Angiogram329 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - ICG Angiogram241 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - ICG Angiogram242 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - SD OCT VIDEO TAKES TIME TO LOAD226 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - SD OCT VIDEO TAKES TIME TO LOAD165 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - SD OCT214 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - SD OCT171 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - SD OCT192 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - SD OCT149 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - SD OCT185 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - SD OCT183 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - SD OCT275 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - SD OCT224 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - SD OCT379 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - SD OCT240 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
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Punctate Inner Choroidopathy - PIC and Choroidal Neovascular Membrane - Right Eye - SD OCT352 views34-year-old woman with a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She does have a history of aches and pains and she was diagnosed with Sjogren’s and 2 months ago she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. OD 20/25, OS 20/20. 00000
(0 votes)
     
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34-year-old woman was seen in the office on 8/7/2012. She has noticed a change in vision in the right eye about eight days ago. Her vision was hazy and she saw waviness in the vision. She thought it would get better, but then it did not. She comes in for an evaluation, noticing, if anything, the vision might be getting a little bit worse. The vision in the left eye is fine. She does have a history of aches and pains and she was diagnosed with Sjogren’s after a series of blood tests were done about a year ago, and she does have intermittent problems. In May she had some fevers and some sinus drainage and that went on for about two months. She is a moderate myope. Her prescription is about -5.5 in both eyes. She takes Restasis for her dry eye. She is also at the moment working on an infertility workup. She is probably going to try in vitro fertilization. Her last menstrual period was about three weeks ago. She also did start Plaquenil for her Sjogren’s syndrome and she did have a brief course of steroid treatment done about a month ago. She had an injection of steroids and then a brief course of oral steroids for about a week, but that is not uncommon for her and she has not had vision problems with that treatment in the past. VISUAL ACUITY: OD 20/25, OS 20/20. IOP: OD 21, OS 18. SLIT LAMP EXAM: The eye is normal with clear lenses. There are no cells in the anterior chamber. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is no posterior vitreous separation. The anterior vitreous is clear of cells. There are some white spots in the posterior pole around the macula and around the optic nerve. There is no optic nerve swelling nor is there any retinal vasculitis or retinitis. There is a small hemorrhage just inferior to the fovea. OS: The left eye similarly has a few spots in the macula just inferior to the fovea and one superotemporal to the fovea. FLUORESCEIN ANGIOGRAPHY: The right eye shows multiple hypofluorescent spots scattered throughout the posterior pole, many of them being about 200 microns in diameter. Then just inferior and nasal to the fovea, about 1000 microns outside the edge of the foveal avascular zone, there is a subretinal neovascular complex almost exactly a disc area in size. In the left eye, there are some patchy hyperfluorescent spots and hypofluorescent spots scattered throughout the posterior pole, more than are visible on the color pictures. In the late frames, the neovascular complex inferonasal to the optic nerve in the right eye does leak and the dark spots, which are hypofluorescent early, do become hyperfluorescent in the late images. SPECTRALIS-SD-OCT SCAN: The OCT scan of the macula in the right eye does show pigment epithelium thickening, predominately inferior to the fovea where the neovascular complex is with some retinal edema there and subretinal fluid centrally. There is also excrescences off of the pigment epithelium where the white spots are, many of which are under the subretinal fluid, but there is some away from it as well. These appear to indent the small spots which are tiny, roughly 150 microns across, do appear to displace all the layers of the retina, including the external limiting membrane and the other outer lines of the retina and appear to be internal to the basement membrane of the choriocapillaris. It doesn’t appear like there is any choroidal involvement on the OCT scan. The scan of the left eye similarly shows no intraretinal or subretinal fluid. There are however, the deposits which appear to be deep pigment epithelium, but superficial to the basement membrane of the choriocapillaris putting them somewhere in the middle of Bruch’s membrane. FUNDUS PHOTOGRAPHY - AUTO FLUORESCENCE: We did some high definition scans of the spots, which similarly show the location to be away from the choroid and we did auto fluorescence images, which show in the right eye hyper auto fluorescence in the area of the retinal detachment. The white spots only have minimal hypo auto fluorescence. The left eye similarly has a few hypo auto fluorescence spots, but there is a spot superotemporal to the fovea, which is hyper auto fluorescencent. INDOCYANINE GREEN ANGIOGRAPHY: The indocyanine green angiogram shows multiple hypofluorescencent spots, many more than are visible on the fluorescein angiogram. Similarly, the left eye shows hypofluorescence early with hyperfluorescence corresponding to the spots and on indocyanine green angiography they are all hypofluorescencent. IMPRESSION: 1. PUNCTATE INNER CHOROIDOPATHY – BOTH EYES 2. SUBFOVEAL CHOROIDAL NEOVASCULAR MEMBRANE - RIGHT EYE 3. SEROUS MACULAR DETACHMENT – RIGHT EYE 4. POSSIBLE FAMILIAR SYNDROME WITH MOTHER HAVING A SIMILAR PROBLEM AT A RELATIVELY YOUNG AGE DISCUSSION: I explained to the patient with intravitreal Avastin there is an excellent chance of drying the neovascular complex in the right eye and there is a recent study out of Asia showing prospectively in over ten patients, that most patients only need a few treatments in this particular syndrome to quiet the eye and with a one year follow-up. I asked her to return for a check in one month.