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71-year-old man has age-related macular degeneration in both eyes. He has previously had choroidal laser treatment in the left eye. He was last here a few years ago. He noticed 4-5 days ago changing vision in the right eye. He did have a YAG capsulotomy done in the right eye in Indiana just a week ago. He has a prescription in the right eye, which interestingly does have hyperopic correction for the right eye. VISUAL ACUITY: Vision OD is 20/25, OS is 5/200. IOP: 14 OU. SLIT LAMP EXAM: The posterior chamber intraocular lens is in good position in both eyes with open capsules. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.3. There is a bullous pigment epithelial detachment under the fovea, less than 4-disc diameters in size. There is no hemorrhage or fluid. OS: Vertical C/D ratio is 0.3. There is a macular scar with a choroidal neovascular membrane and active bleeding and fluid centered on the fovea about 3-disc diameters across. OCT SCAN: The right eye shows a bullous pigment epithelial detachment with trace subretinal fluid in the fovea. The left eye also has intraretinal or subretinal fluid overlying irregular pigment epithelial thickening. FLUORESCEIN ANGIOGRAPHY: Photos confirm clinical findings. FA of the right eye shows a slowly filling pigment epithelial detachment with no significant leakage centrally. The left eye has an irregular staining and leaking macular scar with a block superiorly where the hemorrhage is. IMPRESSION: 1. AGE-RELATED MACULAR DEGENERATION – BOTH EYES 2. BULLOUS PIGMENT EPITHELIAL DETACHMENT – RIGHT EYE 3. POSSIBLE OCCULT SUBFOVEAL CHOROIDAL NEOVASCULAR MEMBRANE – RIGHT EYE 4. CHOROIDAL NEOVASCULAR MEMBRANE WITH MACULAR SCAR AND CHRONIC VISION LOSS – LEFT EYE DISCUSSION: I explained to the patient the left eye looks worse than when he was here a few years ago, but given the duration of vision loss, I do not think treatment today would be helpful. The right eye, with 20/25 vision and a bullous pigment epithelial detachment, probably should be left alone. It is possible to treat these eyes with intravitreal Avastin and Lucentis, but there appears to be a risk of a pigment epithelial tear with those treatments. Given his vision is nearly 20/20, it is possible this is serous and not exudative. I suggest for now we watch the eye. If he starts to worsen, I would probably try intravitreal Kenalog before proceeding to other therapies.

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AMD - Pigment Epithelial Detachment - Possibly Wet240 views71-year-old man 4-5 days ago changing vision in the right eye. VISUAL ACUITY: Vision OD is 20/25, OS is 5/200. 00000
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AMD - Pigment Epithelial Detachment - Possibly Wet172 views71-year-old man 4-5 days ago changing vision in the right eye. VISUAL ACUITY: Vision OD is 20/25, OS is 5/200. 00000
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AMD - Pigment Epithelial Detachment - Possibly Wet120 views71-year-old man 4-5 days ago changing vision in the right eye. VISUAL ACUITY: Vision OD is 20/25, OS is 5/200. 00000
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AMD - Pigment Epithelial Detachment - Possibly Wet129 views71-year-old man 4-5 days ago changing vision in the right eye. VISUAL ACUITY: Vision OD is 20/25, OS is 5/200. 00000
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serouspeddrygeda_28429.jpg
AMD - Pigment Epithelial Detachment - Possibly Wet167 views71-year-old man 4-5 days ago changing vision in the right eye. VISUAL ACUITY: Vision OD is 20/25, OS is 5/200. 00000
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AMD - Pigment Epithelial Detachment - Possibly Wet139 views71-year-old man 4-5 days ago changing vision in the right eye. VISUAL ACUITY: Vision OD is 20/25, OS is 5/200. 00000
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71-year-old man has age-related macular degeneration in both eyes. He has previously had choroidal laser treatment in the left eye. He was last here a few years ago. He noticed 4-5 days ago changing vision in the right eye. He did have a YAG capsulotomy done in the right eye in Indiana just a week ago. He has a prescription in the right eye, which interestingly does have hyperopic correction for the right eye. VISUAL ACUITY: Vision OD is 20/25, OS is 5/200. IOP: 14 OU. SLIT LAMP EXAM: The posterior chamber intraocular lens is in good position in both eyes with open capsules. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.3. There is a bullous pigment epithelial detachment under the fovea, less than 4-disc diameters in size. There is no hemorrhage or fluid. OS: Vertical C/D ratio is 0.3. There is a macular scar with a choroidal neovascular membrane and active bleeding and fluid centered on the fovea about 3-disc diameters across. OCT SCAN: The right eye shows a bullous pigment epithelial detachment with trace subretinal fluid in the fovea. The left eye also has intraretinal or subretinal fluid overlying irregular pigment epithelial thickening. FLUORESCEIN ANGIOGRAPHY: Photos confirm clinical findings. FA of the right eye shows a slowly filling pigment epithelial detachment with no significant leakage centrally. The left eye has an irregular staining and leaking macular scar with a block superiorly where the hemorrhage is. IMPRESSION: 1. AGE-RELATED MACULAR DEGENERATION – BOTH EYES 2. BULLOUS PIGMENT EPITHELIAL DETACHMENT – RIGHT EYE 3. POSSIBLE OCCULT SUBFOVEAL CHOROIDAL NEOVASCULAR MEMBRANE – RIGHT EYE 4. CHOROIDAL NEOVASCULAR MEMBRANE WITH MACULAR SCAR AND CHRONIC VISION LOSS – LEFT EYE DISCUSSION: I explained to the patient the left eye looks worse than when he was here a few years ago, but given the duration of vision loss, I do not think treatment today would be helpful. The right eye, with 20/25 vision and a bullous pigment epithelial detachment, probably should be left alone. It is possible to treat these eyes with intravitreal Avastin and Lucentis, but there appears to be a risk of a pigment epithelial tear with those treatments. Given his vision is nearly 20/20, it is possible this is serous and not exudative. I suggest for now we watch the eye. If he starts to worsen, I would probably try intravitreal Kenalog before proceeding to other therapies.