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81 -year-old woman has wet age-related macular degeneration in both eyes. She has been having intravitreal treatments in the right eye since 2008. Most recently I treated her on November 16th. She noticed, just two days ago, darkness in the right eye and some double vision. VISUAL ACUITY: Vision OD is 20/80, OS is 20/25. IOP: OD 17, OS 18. There is a posterior chamber intraocular lens in good position in both eyes with 2+ posterior capsular opacities. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.4. There is pigment epithelial thickening predominantly nasal to the fovea with a hemorrhage under the center of the fovea. OS: Vertical C/D ratio is 0.4. There is pigment epithelial thickening centrally. There is a ring of hemorrhage predominantly on the nasal edge of the pigment epithelial detachment. SPECTRALIS SD-OCT SCAN: The OCT scan of the right eye shows fluid and blood under the center of the fovea with some of the fluid tracking inferiorly. The scan looks substantially worse than last visit. There is also vitreomacular traction. The OCT scan of the left eye shows some intraretinal fluid predominantly inferior to the fovea and the subretinal blood is visible on the scan nasal to the fovea. There is no frank subretinal fluid though. FUNDUS PHOTOGRAPHY – AUTOFLUORESCENCE: The autofluorescence image of the right eye shows hypoautofluorescence centrally where the blood is but there is hyperautofluorescence around the optic nerve where the pigment epithelial detachment is. The autofluorescence image of the left eye shows a subtle ring of hypoautofluorescence centrally with hypoautofluorescence nasal to the fovea. FLUORESCEIN ANGIOGRAPHY: The right eye shows hypofluorescence where the blood is. In the later frames, there is increasing leakage predominantly on the nasal edge of the fovea but also in the center of the macula. The fluorescein angiogram of the left eye similarly shows hyperfluorescence predominantly on the nasal edge of the fovea along with some hypofluorescence where there is blood. Then there is leakage predominantly nasal to the fovea in the late frame. INDOCYANINE GREEN ANGIOGRAM: In the early frames of the right eye shows a lacy vascular network suggestive of polypoidal choroidal vasculopathy but there are no polyps. The network appears within a minute of the start of the angiogram. The left eye has a similar lacy vascular network. On the indocyanine green angiogram, the neovascular membranes are well-defined in both eyes and very symmetric. They are under the center of the fovea in the right eye measuring 3 mm² and left eye 3 mm².IMPRESSION: 1. WET AGE-RELATED MACULAR DEGENERATION – BOTH EYES 3. MACULAR HEMORRHAGE – BOTH EYES 4. POSTERIOR CAPSULAR OPACITY – BOTH EYES 5. PIGMENT EPITHELIAL DETACHMENT – BOTH EYES DISCUSSION: I explained to the patient she does have wet age-related macular degeneration, which is worse now in both eyes.

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81 -year-old woman has wet age-related macular degeneration in both eyes. She has been having intravitreal treatments in the right eye since 2008. Most recently I treated her on November 16th. She noticed, just two days ago, darkness in the right eye and some double vision. VISUAL ACUITY: Vision OD is 20/80, OS is 20/25. IOP: OD 17, OS 18. There is a posterior chamber intraocular lens in good position in both eyes with 2+ posterior capsular opacities. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.4. There is pigment epithelial thickening predominantly nasal to the fovea with a hemorrhage under the center of the fovea. OS: Vertical C/D ratio is 0.4. There is pigment epithelial thickening centrally. There is a ring of hemorrhage predominantly on the nasal edge of the pigment epithelial detachment. SPECTRALIS SD-OCT SCAN: The OCT scan of the right eye shows fluid and blood under the center of the fovea with some of the fluid tracking inferiorly. The scan looks substantially worse than last visit. There is also vitreomacular traction. The OCT scan of the left eye shows some intraretinal fluid predominantly inferior to the fovea and the subretinal blood is visible on the scan nasal to the fovea. There is no frank subretinal fluid though. FUNDUS PHOTOGRAPHY – AUTOFLUORESCENCE: The autofluorescence image of the right eye shows hypoautofluorescence centrally where the blood is but there is hyperautofluorescence around the optic nerve where the pigment epithelial detachment is. The autofluorescence image of the left eye shows a subtle ring of hypoautofluorescence centrally with hypoautofluorescence nasal to the fovea. FLUORESCEIN ANGIOGRAPHY: The right eye shows hypofluorescence where the blood is. In the later frames, there is increasing leakage predominantly on the nasal edge of the fovea but also in the center of the macula. The fluorescein angiogram of the left eye similarly shows hyperfluorescence predominantly on the nasal edge of the fovea along with some hypofluorescence where there is blood. Then there is leakage predominantly nasal to the fovea in the late frame. INDOCYANINE GREEN ANGIOGRAM: In the early frames of the right eye shows a lacy vascular network suggestive of polypoidal choroidal vasculopathy but there are no polyps. The network appears within a minute of the start of the angiogram. The left eye has a similar lacy vascular network. On the indocyanine green angiogram, the neovascular membranes are well-defined in both eyes and very symmetric. They are under the center of the fovea in the right eye measuring 3 mm² and left eye 3 mm².IMPRESSION: 1. WET AGE-RELATED MACULAR DEGENERATION – BOTH EYES 3. MACULAR HEMORRHAGE – BOTH EYES 4. POSTERIOR CAPSULAR OPACITY – BOTH EYES 5. PIGMENT EPITHELIAL DETACHMENT – BOTH EYES DISCUSSION: I explained to the patient she does have wet age-related macular degeneration, which is worse now in both eyes.