71 Year old woman who noticed about a month ago the central vision in the right eye fogged up. She is on Nevanac and Pred Forte now. Her cataract surgery was done 20 years ago. She had a history of giant cell arteritis, but her sedimentation rate, which was obtained on July 29th, which is today is normal at 23. Her C-reactive protein is also normal. VISUAL ACUITY: OD 20/200, OS 20/30. IOP: OD 10, OS 11. SLIT EXAMINATION: The posterior chamber intraocular lens is in good position in both eyes. The right eye has an open capsule. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.7. The nerve is pale. There is 3+ cystoid macular edema. OS: Vertical C/D ratio is 0.7. The nerve is pale. The macula looks healthy. OCT SCAN: The OCT scan shows an average central foveal thickness in the right eye of 581 microns and the left eye has 194 microns. The right eye has a serous macular detachment. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows cystoid macular edema in the right eye with staining of the macula and the nerve. IMPRESSION: 1. POSSIBLE XALATAN INDUCED CYSTOID MACULAR EDEMA 2. CYSTOID MACULAR EDEMA – RIGHT EYE 3. SEROUS MACULAR DETACHMENT – RIGHT EYE DISCUSSION: I explained to the patient that the macular edema in the right eye is consistent with uveitis and it is possible that she developed a low grade uveitis associated with Xalatan. I asked her to continue what she is doing, which is the Pred Forte and Nevanac drops, to stay off the Xalatan and to return for a check in one month. I am hopeful by then the macula will have dried out Follow-up 3 months later: 71-year-old woman has cystoid macular edema in the right eye when she started her Xalatan. She is off the Xalatan. She has been using Nevanac and Pred Forte and her vision is good. VISUAL ACUITY: OD 20/40. IOP: 12. The posterior chamber intraocular lens is in good position. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.7. The nerve is pale. The macula is dry. OCT SCAN: The OCT scan shows an average central foveal thickness of 191 microns, which is better than 581 microns in July. |
|||||||
|
|
|
|
||||
|
|
|
|
||||
|
|
|
|
||||
|
|
||||||
|
|||||||
71 Year old woman who noticed about a month ago the central vision in the right eye fogged up. She is on Nevanac and Pred Forte now. Her cataract surgery was done 20 years ago. She had a history of giant cell arteritis, but her sedimentation rate, which was obtained on July 29th, which is today is normal at 23. Her C-reactive protein is also normal. VISUAL ACUITY: OD 20/200, OS 20/30. IOP: OD 10, OS 11. SLIT EXAMINATION: The posterior chamber intraocular lens is in good position in both eyes. The right eye has an open capsule. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.7. The nerve is pale. There is 3+ cystoid macular edema. OS: Vertical C/D ratio is 0.7. The nerve is pale. The macula looks healthy. OCT SCAN: The OCT scan shows an average central foveal thickness in the right eye of 581 microns and the left eye has 194 microns. The right eye has a serous macular detachment. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows cystoid macular edema in the right eye with staining of the macula and the nerve. IMPRESSION: 1. POSSIBLE XALATAN INDUCED CYSTOID MACULAR EDEMA 2. CYSTOID MACULAR EDEMA – RIGHT EYE 3. SEROUS MACULAR DETACHMENT – RIGHT EYE DISCUSSION: I explained to the patient that the macular edema in the right eye is consistent with uveitis and it is possible that she developed a low grade uveitis associated with Xalatan. I asked her to continue what she is doing, which is the Pred Forte and Nevanac drops, to stay off the Xalatan and to return for a check in one month. I am hopeful by then the macula will have dried out Follow-up 3 months later: 71-year-old woman has cystoid macular edema in the right eye when she started her Xalatan. She is off the Xalatan. She has been using Nevanac and Pred Forte and her vision is good. VISUAL ACUITY: OD 20/40. IOP: 12. The posterior chamber intraocular lens is in good position. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.7. The nerve is pale. The macula is dry. OCT SCAN: The OCT scan shows an average central foveal thickness of 191 microns, which is better than 581 microns in July.
