85-year-old woman has wet age-related macular degeneration in the left eye. That was her better eye and she was reading with it until two days ago when she had sudden severe vision loss in the eye. Her last injection with Avastin was July 14th. VISUAL ACUITY: Vision OS is 20/160. IOP: OS 12. There is a posterior chamber intraocular lens in good position. EXTENDED OPHTHALMOSCOPY: OS: Vertical C/D ratio is 0.3. There is a submacular scar surrounded with blood. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: The FA shows hypofluorescence corresponding to the blood. IMPRESSION: 1. SUBRETINAL HEMORRHAGE – LEFT EYE DISCUSSION: I explained to the patient that with the fresh subretinal hemorrhage, unfortunately her chance of visual recovery is probably no more than 50%. It is possible to surgically displace the subretinal blood by creating a bleb of tissue plasminogen activator over it and then having the patient sit upright. I have discussed the risks, benefits and alternatives to her. She is enthusiastic about proceeding with the surgery 4 month follow-up 85-year-old woman has wet age-related macular degeneration in both eyes. She developed a subretinal hemorrhage in her left and better eye which I displaced surgically on July 24th and she has been having Avastin treatments since then. Her vision unfortunately, although improved some, is still limited. She is still able to see well enough to do crossword puzzles. The vision in the right eye is limited from macular scars which were treated with photodynamic laser in 2002 and 2003. VISUAL ACUITY: Vision OU is 20/120. IOP: OD 11, OS 13. The posterior chamber intraocular lens is in good position in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.3. There are pigment epithelial irregularities centrally. There is no intraretinal or subretinal fluid. OS: Vertical C/D ratio is 0.3. There is pigment epithelial thickening centrally with scarring with a rim of atrophy around it. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: The right eye shows a staining macular scar. The left eye shows staining pigment epithelium with overlying atrophy. There is a hypofluorescent spot centrally which looks to be probable residual subpigment epithelial foveal blood. There is no leakage in either eye. IMPRESSION: 1. AGE-RELATED MACULAR DEGENERATION – BOTH EYES 2. INVOLUTED SUBFOVEAL CHOROIDAL NEOVASCULAR MEMBRANE – LEFT EYE 3. REABSORBING SUBRETINAL PIGMENT EPITHELIAL HEMORRHAGE – LEFT EYE 4. MACULAR SCARS – BOTH EYES DISCUSSION: I explained to the patient the macula in the left eye does look like it has dried out nicely. I injected the eye with Lucentis (0.5 mg/0.05 ml) today without any difficulty in hopes of possibly improving her vision further. |
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85-year-old woman has wet age-related macular degeneration in the left eye. That was her better eye and she was reading with it until two days ago when she had sudden severe vision loss in the eye. Her last injection with Avastin was July 14th. VISUAL ACUITY: Vision OS is 20/160. IOP: OS 12. There is a posterior chamber intraocular lens in good position. EXTENDED OPHTHALMOSCOPY: OS: Vertical C/D ratio is 0.3. There is a submacular scar surrounded with blood. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: The FA shows hypofluorescence corresponding to the blood. IMPRESSION: 1. SUBRETINAL HEMORRHAGE – LEFT EYE DISCUSSION: I explained to the patient that with the fresh subretinal hemorrhage, unfortunately her chance of visual recovery is probably no more than 50%. It is possible to surgically displace the subretinal blood by creating a bleb of tissue plasminogen activator over it and then having the patient sit upright. I have discussed the risks, benefits and alternatives to her. She is enthusiastic about proceeding with the surgery 4 month follow-up 85-year-old woman has wet age-related macular degeneration in both eyes. She developed a subretinal hemorrhage in her left and better eye which I displaced surgically on July 24th and she has been having Avastin treatments since then. Her vision unfortunately, although improved some, is still limited. She is still able to see well enough to do crossword puzzles. The vision in the right eye is limited from macular scars which were treated with photodynamic laser in 2002 and 2003. VISUAL ACUITY: Vision OU is 20/120. IOP: OD 11, OS 13. The posterior chamber intraocular lens is in good position in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.3. There are pigment epithelial irregularities centrally. There is no intraretinal or subretinal fluid. OS: Vertical C/D ratio is 0.3. There is pigment epithelial thickening centrally with scarring with a rim of atrophy around it. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: The right eye shows a staining macular scar. The left eye shows staining pigment epithelium with overlying atrophy. There is a hypofluorescent spot centrally which looks to be probable residual subpigment epithelial foveal blood. There is no leakage in either eye. IMPRESSION: 1. AGE-RELATED MACULAR DEGENERATION – BOTH EYES 2. INVOLUTED SUBFOVEAL CHOROIDAL NEOVASCULAR MEMBRANE – LEFT EYE 3. REABSORBING SUBRETINAL PIGMENT EPITHELIAL HEMORRHAGE – LEFT EYE 4. MACULAR SCARS – BOTH EYES DISCUSSION: I explained to the patient the macula in the left eye does look like it has dried out nicely. I injected the eye with Lucentis (0.5 mg/0.05 ml) today without any difficulty in hopes of possibly improving her vision further.
