87-year-old woman was seen in the office on 10-12-06. She has had gradually declining vision in the left eye over the last month. She notices when she looks at television that things look wrong and that the vision in the left eye is not normal. The right eye is seeing fine and previous to this she felt the two eyes saw equally. VISUAL ACUITY: OD: 20/30; OS: 20/60. IOP: OD: 15, OS: 16. AMSLER GRID: OD: Normal. OS: Central metamorphopsia. SLIT LAMP EXAM: The posterior chamber intraocular lens is in good position in both eyes. The left eye has an open capsule. EXTENDED OPHTHALMOSCOPY: OD: C/D ratio is 0.3. There is a posterior vitreous separation and 2+ macular drusen. There is no subretinal fluid, hemorrhage or exudate. OS: C/D ratio is 0.3. There is a posterior vitreous separation. There is 2+ macular edema with patchy retinal hemorrhages temporal to the fovea and thickening of the pigment epithelium. An OCT scan of the right eye shows a normal foveal contour with mild thickening of the pigment epithelium centrally. The left eye has thickening of the macula with macular edema temporal to the fovea and an irregular pigment epithelial detachment under the fovea. A fluorescein angiogram focusing on the left eye shows central hyperfluorescence with a stippled disc-diameter occult subfoveal choroidal neovascular membrane with leakage. The right eye has a few staining drusen. IMPRESSION: 1. AGE-RELATED MACULAR DEGENERATION IN BOTH EYES. 2. WET AGE-RELATED MACULAR DEGENERATION IN THE LEFT EYE. 3. MACULAR EDEMA IN THE LEFT EYE. 4. RECENT VISION LOSS IN THE LEFT EYE. DISCUSSION: I explained to the patient that given the recent vision loss and the wet age-related macular degeneration she is an excellent candidate for intravitreal Kenalog followed by Lucentis therapy to hopefully dry up the macula and bring the wet age-related macular degeneration under control. This has a reasonable chance of improving her vision over the next few months. I injected the eye with Kenalog 4 mg/0.05 ml today. She is to return for a check in a few weeks for probable Lucentis treatment and see you back regularly. With treatment with Lucentis, Avastin, Kenalog VA declined to 20/200 |
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87-year-old woman was seen in the office on 10-12-06. She has had gradually declining vision in the left eye over the last month. She notices when she looks at television that things look wrong and that the vision in the left eye is not normal. The right eye is seeing fine and previous to this she felt the two eyes saw equally. VISUAL ACUITY: OD: 20/30; OS: 20/60. IOP: OD: 15, OS: 16. AMSLER GRID: OD: Normal. OS: Central metamorphopsia. SLIT LAMP EXAM: The posterior chamber intraocular lens is in good position in both eyes. The left eye has an open capsule. EXTENDED OPHTHALMOSCOPY: OD: C/D ratio is 0.3. There is a posterior vitreous separation and 2+ macular drusen. There is no subretinal fluid, hemorrhage or exudate. OS: C/D ratio is 0.3. There is a posterior vitreous separation. There is 2+ macular edema with patchy retinal hemorrhages temporal to the fovea and thickening of the pigment epithelium. An OCT scan of the right eye shows a normal foveal contour with mild thickening of the pigment epithelium centrally. The left eye has thickening of the macula with macular edema temporal to the fovea and an irregular pigment epithelial detachment under the fovea. A fluorescein angiogram focusing on the left eye shows central hyperfluorescence with a stippled disc-diameter occult subfoveal choroidal neovascular membrane with leakage. The right eye has a few staining drusen. IMPRESSION: 1. AGE-RELATED MACULAR DEGENERATION IN BOTH EYES. 2. WET AGE-RELATED MACULAR DEGENERATION IN THE LEFT EYE. 3. MACULAR EDEMA IN THE LEFT EYE. 4. RECENT VISION LOSS IN THE LEFT EYE. DISCUSSION: I explained to the patient that given the recent vision loss and the wet age-related macular degeneration she is an excellent candidate for intravitreal Kenalog followed by Lucentis therapy to hopefully dry up the macula and bring the wet age-related macular degeneration under control. This has a reasonable chance of improving her vision over the next few months. I injected the eye with Kenalog 4 mg/0.05 ml today. She is to return for a check in a few weeks for probable Lucentis treatment and see you back regularly. With treatment with Lucentis, Avastin, Kenalog VA declined to 20/200
