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Top rated - Juxtafoveal Telangiectasia - Before and After New Hemorrhage Right Eye
70-year-old woman was seen in the office on 12-10-07. You suggested she come in earlier than usual because her vision had changed. She does notice her vision getting worse and she has had more difficulty with visual tasks, such as reading, especially reading music. VISUAL ACUITY: OD: 20/160; OD: 20/80. IOP: OD: 18, OS: 19. There is 2+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: C/D ratio is 0.3. There are crystals and telangietactic vessels temporal to the fovea. There is no subretinal fluid, hemorrhage or exudate. OS: Vertical C/D ratio is 0.3. There are several telangiectatic vessels under the fovea. There is no subretinal fluid, hemorrhage or exudate. The OCT scan shows intraretinal pockets of fluid, but no subretinal fluid, and the retina is retaining normal foveal thickness, if anything it is a little bit atrophic. A fluorescein angiogram was obtained today because of her vision change, which shows typical leakage from the parafoveal retinal vessels. However, the fovea itself remains dry and there is no evidence of choroidal neovascularization. IMPRESSION: 1. TYPE GROUP II-A IDIOPATHIC JUXTAFOVEAL RETINAL TELANGIECTASIS IN BOTH EYES – STAGE 4 IN THE RIGHT EYE, STAGE 2 IN THE LEFT EYE. DISCUSSION: I explained to the patient that her maculae remain relatively stable. Unfortunately, the new evidence suggests that shots like Avastin and Kenalog probably do not help people very much with retinal telangiectasis. I suggested for now to leave the eyes alone. I did, however, ask her to return for a check in three months. 3 months later NEW RETINAL HEME: 71-year-old woman was seen in the office on 9/2/08. She is a long-standing patient of mine. She has type IIA juxtafoveal retinal telangiectasis in both eyes. I have not seen her since the year 2000 for that and her vision in the right eye has been limited for some time. She did notice the right eye getting worse. She had a fall about three weeks ago. She hit her right side hard and had a little bit of a chest compression with that. She is not sure, but that may have been when the vision declined. VISUAL ACUITY: Vision OD is 20/160, OS is 20/40. IOP: OU22. SLIT LAMP EXAM: There is 2+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.4. There is a retinal hemorrhage on the nasal portion of the optic nerve which involves the fovea. OS: Vertical C/D ratio is 0.5. There is graying of the temporal retina. OCT SCAN: The right eye shows thickening of the retina with what looks like a central pigment epithelial detachment and thickening of the superficial retina. The left eye has a few voids centrally. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: FA shows hyperfluorescence in the right eye where the retinal hemorrhage is. Some of the hypofluorescence looks to be very superficial, in fact preretinal but some of it is intraretinal. There is a slight slow in the late frames, which looks a little different than previously, suggesting a possible choroidal neovascular complex. The left eye has typical leakage in the late frames temporally, consistent with retinal telangiectasis. IMPRESSION: 1. GROUP IIA JUXTAFOVEAL RETINAL TELANGIECTASIS – BOTH EYES 2. AGE-RELATED MACULAR DEGENERATION – RIGHT EYE 3. RETINAL HEMORRHAGE – RIGHT EYE 4. NEW ONSET CHOROIDAL NEOVASCULAR MEMBRANE – RIGHT EYE 5. POSSIBLE CONCOMITANT VALSALVA RETINOPATHY – RIGHT EYE DISCUSSION: I explained to the patient the right eye does have some blood in the macula. It looks also to be accompanied by a choroidal neovascular membrane. I suggested Avastin treatment to reduce the risk of vision loss in that eye and possibly to facilitate visual improvement. Although the visual potential in that eye is limited, she has noticed a decline in her subjective visual acuity, and with the retinal hemorrhage I think it would be prudent to try to treat her. |
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70-year-old woman was seen in the office on 12-10-07. You suggested she come in earlier than usual because her vision had changed. She does notice her vision getting worse and she has had more difficulty with visual tasks, such as reading, especially reading music. VISUAL ACUITY: OD: 20/160; OD: 20/80. IOP: OD: 18, OS: 19. There is 2+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: C/D ratio is 0.3. There are crystals and telangietactic vessels temporal to the fovea. There is no subretinal fluid, hemorrhage or exudate. OS: Vertical C/D ratio is 0.3. There are several telangiectatic vessels under the fovea. There is no subretinal fluid, hemorrhage or exudate. The OCT scan shows intraretinal pockets of fluid, but no subretinal fluid, and the retina is retaining normal foveal thickness, if anything it is a little bit atrophic. A fluorescein angiogram was obtained today because of her vision change, which shows typical leakage from the parafoveal retinal vessels. However, the fovea itself remains dry and there is no evidence of choroidal neovascularization. IMPRESSION: 1. TYPE GROUP II-A IDIOPATHIC JUXTAFOVEAL RETINAL TELANGIECTASIS IN BOTH EYES – STAGE 4 IN THE RIGHT EYE, STAGE 2 IN THE LEFT EYE. DISCUSSION: I explained to the patient that her maculae remain relatively stable. Unfortunately, the new evidence suggests that shots like Avastin and Kenalog probably do not help people very much with retinal telangiectasis. I suggested for now to leave the eyes alone. I did, however, ask her to return for a check in three months. 3 months later NEW RETINAL HEME: 71-year-old woman was seen in the office on 9/2/08. She is a long-standing patient of mine. She has type IIA juxtafoveal retinal telangiectasis in both eyes. I have not seen her since the year 2000 for that and her vision in the right eye has been limited for some time. She did notice the right eye getting worse. She had a fall about three weeks ago. She hit her right side hard and had a little bit of a chest compression with that. She is not sure, but that may have been when the vision declined. VISUAL ACUITY: Vision OD is 20/160, OS is 20/40. IOP: OU22. SLIT LAMP EXAM: There is 2+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.4. There is a retinal hemorrhage on the nasal portion of the optic nerve which involves the fovea. OS: Vertical C/D ratio is 0.5. There is graying of the temporal retina. OCT SCAN: The right eye shows thickening of the retina with what looks like a central pigment epithelial detachment and thickening of the superficial retina. The left eye has a few voids centrally. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: FA shows hyperfluorescence in the right eye where the retinal hemorrhage is. Some of the hypofluorescence looks to be very superficial, in fact preretinal but some of it is intraretinal. There is a slight slow in the late frames, which looks a little different than previously, suggesting a possible choroidal neovascular complex. The left eye has typical leakage in the late frames temporally, consistent with retinal telangiectasis. IMPRESSION: 1. GROUP IIA JUXTAFOVEAL RETINAL TELANGIECTASIS – BOTH EYES 2. AGE-RELATED MACULAR DEGENERATION – RIGHT EYE 3. RETINAL HEMORRHAGE – RIGHT EYE 4. NEW ONSET CHOROIDAL NEOVASCULAR MEMBRANE – RIGHT EYE 5. POSSIBLE CONCOMITANT VALSALVA RETINOPATHY – RIGHT EYE DISCUSSION: I explained to the patient the right eye does have some blood in the macula. It looks also to be accompanied by a choroidal neovascular membrane. I suggested Avastin treatment to reduce the risk of vision loss in that eye and possibly to facilitate visual improvement. Although the visual potential in that eye is limited, she has noticed a decline in her subjective visual acuity, and with the retinal hemorrhage I think it would be prudent to try to treat her.
