1 All the participants with UAIM in one study had an exudative macular detachment, spontaneous resolution of the macular changes and near-complete recovery of their vision. UAIM was originally described as sudden vision loss following a flu-like illness. Based on the clinical appearance and OCT findings, this is likely a post-viral process, such as UAIM. This appeared to be an acute, unilateral process affecting the outer retina. Interestingly, there was a larger irregular area nasal to the fovea where there was also staining. The FA showed a central area of hypofluorescence with surrounding hyperfluorescent staining but no leakage of the fluorescein dye, which is not consistent with CNV. There was no subretinal or intraretinal fluid, which was consistent with our clinical exam. The OCT showed a focal hyperreflective lesion in the outer retina corresponding to the yellow lesion with central IS/OS junction disruption. How do you interpret this SD-OCT of the left eye (left)? What do the macular changes represent in this late-phase FA of the left eye (right)? Click image to enlarge. Instead, we saw some retinal pigment epithelium (RPE) disruption and this peculiar yellow lesion.įigs. The macula appeared flat, and there was no subretinal fluid or hemorrhage present. There was a deep yellow-appearing lesion in the macula that could possibly be a drusen, but the other clinical findings in the left eye don’t fit with CNV. The problem is that she didn’t have any drusen in the macula of her right eye, which you would expect to see if she had AMD, as the dry form is usually a bilateral symmetric disease. Rapid decline in her central vision without treatmentīased on the patient’s history of sudden blurred vision in the left eye and the presence of drusen along the arcades, our initial thought was that she had macular degeneration and had likely developed a choroidal neovascularization in her left eye. Slow steady improvement of her vision over timeĬ. Reasonably good central vision with treatmentī. What would you expect her clinical prognosis to be?Ī. Unilateral acute idiopathic maculopathy (UAIM)Ĥ. Multiple evanescent white dot syndrome (MEWDS)ĭ. Wet age-related macular degeneration (AMD)Ĭ. How would you describe the OCT appearance?ī. Note the macular appearance of the left eye. This is a fundus photograph of the right and left eyes of our patient. OCT and fluorescein angiography (FA) were performed and are available for review ( Figures 2 and 3).įig. There did not appear to be any subretinal fluid. In the macula, there was a deep yellow-white lesion ( Figure 1). We noted similar peripheral drusen in the left eye. On dilated fundus exam of the right eye, there were peripheral drusen along the arcades. The anterior segment examination was remarkable for trace nuclear sclerosis OU. The left eye showed central metamorphopsia. Amsler grid testing in the right eye was normal. The pupils were equally round and strongly reactive there was no afferent pupillary defect. Confrontation visual fields were full-to-careful finger counting OU. Her extraocular motility testing was normal. On examination, entering distance acuities measured 20/20 OD and 20/40 OS. She is currently on hydrochlorothiazide and losartan. Medical history was significant for hypertension and osteoporosis. She wore a hyperopic correction with a progressive lens. Her last eye exam was three to four years ago. She said her right eye was “perfect,” but, when she covered it, she could immediately see her central vision was blurred. She reported that, while working on an Excel spreadsheet, parts of the line of text were missing. A 63-year-old Hispanic female presented with a two-day history of blurred vision in her left eye.
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