81-year-old woman was seen in the office on 12/19/08. Her left eye is amblyopic. Her right eye was doing fine until about last Sunday, which is five days ago. She had a change in vision where for five minutes she saw a shadow in her side vision out of the right eye. She describes it as being more up into the left. It lasted for just a brief time and then went away. She has had floaters in that eye and the floaters are still there. She has not noticed a substantial increase in floaters.
She has had atrial fibrillation since January of 2008. She is on Coumadin for that. She is diabetic for eleven years. She also had a droopy eyelid on the left side about eight years ago. She had some testing done and she was shown at that time to have had a left occipital stroke, which was probably old. She did not notice any neurological changes with this recent episode five days ago. You saw her and during the exam noticed a peripheral retinal tear and suggested she come in here for an evaluation.
VISUAL ACUITY: Vision OD is 20/250, OS is 20/60. IOP: OD 15, OS 18.
SLIT LAMP EXAM: The right eye has 1+ corneal guttata. The posterior chamber intraocular lens is in good position with 2+ posterior capsular opacity. The left eye has 1+ corneal guttata and a posterior chamber intraocular lens with 2+ posterior capsular opacity and open capsule.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.5. There is a posterior vitreous separation. There is a Hollenhorst plaque just inferior to the fovea and a minor branch retinal arteriole. Also, with scleral depression there was a fresh superotemporal retinal tear with a subclinical detachment at 11:00 o’clock at the equator with hemorrhage at the edge of the tear.
OS: Vertical C/D ratio is 0.5. There is a posterior vitreous separation. The macula and periphery look healthy.
FLUORESCEIN ANGIOGRAPHY: Photos confirm clinical findings. The FA shows a tiny area of blockage and a branch retinal arteriole from the Hollenhorst plaque. The fovea though is nicely perfused. The left eye is angiographically normal.
IMPRESSION:
1. TWIG BRANCH RETINAL ARTERIAL OCCLUSION – RIGHT EYE
2. HOLLENHORST PLAQUE – RIGHT EYE
3. NEW PERIPHERAL RETINAL TEAR WITH A SUBCLINICAL RETINAL DETACHMENT – RIGHT EYE
4. AMBLYOPIA – LEFT EYE
DISCUSSION: I explained to the patient she does have two distinct and new problems in the right eye. One is the branch retinal arteriole, which I think was responsible for her transient symptoms of vision change in the right eye. I suspect she briefly blocked a large branch retinal arteriole and then the plaque broke up and now there is a little residual plaque in one of the branches. This does count as a tiny stroke, and I will contact her doctor to have her evaluated for possible stroke risks. She said she had carotid studies done, but it was some time ago. She also should make sure she is adequately anticoagulated with her Coumadin.
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Old BRAO twig with plaque878 views81-year-old woman Her left eye is amblyopic. Her right eye was doing fine until about last Sunday, which is five days ago. She had a change in vision where for five minutes she saw a shadow in her side vision out of the right eye. She describes it as being more up into the left. It lasted for just a brief time and then went away. She has had atrial fibrillation since January of 2008. She is on Coumadin for that. She is diabetic for eleven years. OD is 20/25, OS is 20/60. IOP: OD 15, OS 18. 
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Old BRAO twig with plaque648 views81-year-old woman Her left eye is amblyopic. Her right eye was doing fine until about last Sunday, which is five days ago. She had a change in vision where for five minutes she saw a shadow in her side vision out of the right eye. She describes it as being more up into the left. It lasted for just a brief time and then went away. She has had atrial fibrillation since January of 2008. She is on Coumadin for that. She is diabetic for eleven years. OD is 20/25, OS is 20/60. IOP: OD 15, OS 18.
(0 votes)
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Old BRAO twig with plaque629 views81-year-old woman Her left eye is amblyopic. Her right eye was doing fine until about last Sunday, which is five days ago. She had a change in vision where for five minutes she saw a shadow in her side vision out of the right eye. She describes it as being more up into the left. It lasted for just a brief time and then went away. She has had atrial fibrillation since January of 2008. She is on Coumadin for that. She is diabetic for eleven years. OD is 20/25, OS is 20/60. IOP: OD 15, OS 18.
(0 votes)
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81-year-old woman was seen in the office on 12/19/08. Her left eye is amblyopic. Her right eye was doing fine until about last Sunday, which is five days ago. She had a change in vision where for five minutes she saw a shadow in her side vision out of the right eye. She describes it as being more up into the left. It lasted for just a brief time and then went away. She has had floaters in that eye and the floaters are still there. She has not noticed a substantial increase in floaters.
She has had atrial fibrillation since January of 2008. She is on Coumadin for that. She is diabetic for eleven years. She also had a droopy eyelid on the left side about eight years ago. She had some testing done and she was shown at that time to have had a left occipital stroke, which was probably old. She did not notice any neurological changes with this recent episode five days ago. You saw her and during the exam noticed a peripheral retinal tear and suggested she come in here for an evaluation.
VISUAL ACUITY: Vision OD is 20/250, OS is 20/60. IOP: OD 15, OS 18.
SLIT LAMP EXAM: The right eye has 1+ corneal guttata. The posterior chamber intraocular lens is in good position with 2+ posterior capsular opacity. The left eye has 1+ corneal guttata and a posterior chamber intraocular lens with 2+ posterior capsular opacity and open capsule.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.5. There is a posterior vitreous separation. There is a Hollenhorst plaque just inferior to the fovea and a minor branch retinal arteriole. Also, with scleral depression there was a fresh superotemporal retinal tear with a subclinical detachment at 11:00 o’clock at the equator with hemorrhage at the edge of the tear.
OS: Vertical C/D ratio is 0.5. There is a posterior vitreous separation. The macula and periphery look healthy.
FLUORESCEIN ANGIOGRAPHY: Photos confirm clinical findings. The FA shows a tiny area of blockage and a branch retinal arteriole from the Hollenhorst plaque. The fovea though is nicely perfused. The left eye is angiographically normal.
IMPRESSION:
1. TWIG BRANCH RETINAL ARTERIAL OCCLUSION – RIGHT EYE
2. HOLLENHORST PLAQUE – RIGHT EYE
3. NEW PERIPHERAL RETINAL TEAR WITH A SUBCLINICAL RETINAL DETACHMENT – RIGHT EYE
4. AMBLYOPIA – LEFT EYE
DISCUSSION: I explained to the patient she does have two distinct and new problems in the right eye. One is the branch retinal arteriole, which I think was responsible for her transient symptoms of vision change in the right eye. I suspect she briefly blocked a large branch retinal arteriole and then the plaque broke up and now there is a little residual plaque in one of the branches. This does count as a tiny stroke, and I will contact her doctor to have her evaluated for possible stroke risks. She said she had carotid studies done, but it was some time ago. She also should make sure she is adequately anticoagulated with her Coumadin.
