Myopic CNVM Extrafoveal Small
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55-year-old woman was seen in the office on 1/6/09. She was seen in our practice in 1999 because of her high myopia. You removed her cataract, and her vision was doing fine until about two to three months ago when she had fluctuating vision. She saw an optometrist who changed her glasses several times and put her on drops on and off. She then saw you recently and you saw a problem with the macula and suggested she come in here for evaluation. She had breast cancer in 2002, which was localized.
VISUAL ACUITY: Vision OD is 20/40, OS is 20/20. IOP: 15 OU.
SLIT LAMP EXAM: The posterior chamber intraocular lens is in perfect position in both eyes with open capsules.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.5. There is a posterior vitreous separation. There is peripapillary atrophy. There is a posterior macular staphyloma on the inferior edge of the fovea. There is a hyperpigmented disc diameter choroidal neovascular membrane with fluid touching the fovea.
OS: Vertical C/D ratio is 0.5. There is a posterior vitreous separation. There is peripapillary atrophy. Again, there is a posterior staphyloma, predominantly on the inferior of the macula but also foveally.
OCT SCAN: OCT scan of the right eye shows macular edema.
PHOTOGRAPHS: Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: FA shows a classic extrafoveal choroidal neovascular membrane a disc diameter in size. Also, there is peripapillary atrophy in both eyes. There is a lacquer crack in the left eye, greater than a disc diameter from the fovea.
IMPRESSION:
1. MYOPIC MACULAR DEGENERATION – BOTH EYES
2. CHOROIDAL NEOVASCULAR MEMBRANE – RIGHT EYE
3. MACULAR EDEMA – RIGHT EYE
4. PIGMENT EPITHELIAL DETACHMENT – RIGHT EYE
DISCUSSION: I explained to the patient that unfortunately the patient does have wet macular degeneration. With intravitreal Avastin, we can reduce the risk of vision loss and there is a 90% chance of improving the vision. She understands this is an ongoing therapy. Generally in patients as young as she though, there is a high probability we will be able to discontinue the therapy eventually. I suggested a course of monthly injections for three months and then close follow-up following that.
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Myopic CNVM - Wet - rx Avastin for 1 year466 views55-year-old woman OD is 20/40, OS is 20/20. There is a hyperpigmented disc diameter choroidal neovascular membrane with fluid touching the fovea.
(0 votes)
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Myopic CNVM - Wet - rx Avastin for 1 year399 views55-year-old woman OD is 20/40, OS is 20/20. There is a hyperpigmented disc diameter choroidal neovascular membrane with fluid touching the fovea.
(0 votes)
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Myopic CNVM - Wet - rx Avastin for 1 year468 views55-year-old woman OD is 20/40, OS is 20/20. There is a hyperpigmented disc diameter choroidal neovascular membrane with fluid touching the fovea.
(0 votes)
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Myopic CNVM - Wet - rx Avastin for 1 year713 views55-year-old woman OD is 20/40, OS is 20/20. There is a hyperpigmented disc diameter choroidal neovascular membrane with fluid touching the fovea.
(1 votes)
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Myopic CNVM - Wet - rx Avastin for 1 year392 views55-year-old woman OD is 20/40, OS is 20/20. There is a hyperpigmented disc diameter choroidal neovascular membrane with fluid touching the fovea.
(0 votes)
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Myopic CNVM - Wet - rx Avastin for 1 year405 views55-year-old woman OD is 20/40, OS is 20/20. There is a hyperpigmented disc diameter choroidal neovascular membrane with fluid touching the fovea.
(0 votes)
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Myopic CNVM - Wet - rx Avastin for 1 year378 views55-year-old woman OD is 20/40, OS is 20/20. There is a hyperpigmented disc diameter choroidal neovascular membrane with fluid touching the fovea.
(0 votes)
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Myopic CNVM - Wet - rx Avastin for 1 year396 views55-year-old woman OD is 20/40, OS is 20/20. There is a hyperpigmented disc diameter choroidal neovascular membrane with fluid touching the fovea.
(0 votes)
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Myopic CNVM - Wet - rx Avastin for 1 year415 views55-year-old woman OD is 20/40, OS is 20/20. There is a hyperpigmented disc diameter choroidal neovascular membrane with fluid touching the fovea.
(0 votes)
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55-year-old woman was seen in the office on 1/6/09. She was seen in our practice in 1999 because of her high myopia. You removed her cataract, and her vision was doing fine until about two to three months ago when she had fluctuating vision. She saw an optometrist who changed her glasses several times and put her on drops on and off. She then saw you recently and you saw a problem with the macula and suggested she come in here for evaluation. She had breast cancer in 2002, which was localized.
VISUAL ACUITY: Vision OD is 20/40, OS is 20/20. IOP: 15 OU.
SLIT LAMP EXAM: The posterior chamber intraocular lens is in perfect position in both eyes with open capsules.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.5. There is a posterior vitreous separation. There is peripapillary atrophy. There is a posterior macular staphyloma on the inferior edge of the fovea. There is a hyperpigmented disc diameter choroidal neovascular membrane with fluid touching the fovea.
OS: Vertical C/D ratio is 0.5. There is a posterior vitreous separation. There is peripapillary atrophy. Again, there is a posterior staphyloma, predominantly on the inferior of the macula but also foveally.
OCT SCAN: OCT scan of the right eye shows macular edema.
PHOTOGRAPHS: Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: FA shows a classic extrafoveal choroidal neovascular membrane a disc diameter in size. Also, there is peripapillary atrophy in both eyes. There is a lacquer crack in the left eye, greater than a disc diameter from the fovea.
IMPRESSION:
1. MYOPIC MACULAR DEGENERATION – BOTH EYES
2. CHOROIDAL NEOVASCULAR MEMBRANE – RIGHT EYE
3. MACULAR EDEMA – RIGHT EYE
4. PIGMENT EPITHELIAL DETACHMENT – RIGHT EYE
DISCUSSION: I explained to the patient that unfortunately the patient does have wet macular degeneration. With intravitreal Avastin, we can reduce the risk of vision loss and there is a 90% chance of improving the vision. She understands this is an ongoing therapy. Generally in patients as young as she though, there is a high probability we will be able to discontinue the therapy eventually. I suggested a course of monthly injections for three months and then close follow-up following that.
