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Here you’ll find interesting cases of eye conditions along with news and developments in the ophthalmology world.

Cases are presented as an initial image with history and examination. Health practitioners are encouraged to deduce the condition, before further investigations, diagnosis and management are presented.

We hope you find it as educational, informative and exciting as we do!

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Colour photograph of the right fundus at presentation demonstrates retinal pallor with a cherry red spot at the macula. The cup disc ratio is enlarged.

Figure 1. Colour photograph of the right fundus at presentation demonstrates retinal pallor with a cherry red spot at the macula. The cup disc ratio is enlarged.

Case 25

Author: Michael Chilov     Editor: Adrian Fung

A 68-year old man was referred with profound vision loss one day following cataract surgery.

Case history

A 68-year-old retired accountant was referred by his ophthalmologist with profound vision loss noted on the first day following right femtosecond laser assisted cataract surgery. The patient had sub-Tenon’s anaesthesia and there had been no documented intraoperative complication.

Past ophthalmic history was only notable for myopia with a preoperative refraction of –1.50/ -1.00x 91° (right eye) and -0.25/ -1.25 x 86° (left eye). Past medical history included recently diagnosed Parkinson’s disease treated with Sifrolâ (pramipexole) and hypercholesterolaemia treated with Pravacholâ (pravastatin). There was no history of smoking or previous cardiovascular events such as stroke or heart attack.

Visual acuity was hand movements (HM) OD and 6/7.5-1 OS. There was a right relative afferent pupil defect suggesting optic nerve or diffuse retinal pathology. Eye movements and lid opening were full and there was no subconjunctival or periocular haemorrhage nor exophthalmos to suggest a retrobulbar haemorrhage. The cornea was clear with no significant corneal oedema, and ½+ anterior chamber cells were noted. The intraocular lens was in the bag and well centred. There was a grade 2 nuclear and cortical cataract in the left eye. Intraocular pressures were 14mmHg OD and 16 mmHg OS.

Fundus examination of the right eye demonstrated a pale retina with cherry red spot at the macula (Figure 1). The cup disc ratio was enlarged at 0.8 OD and 0.6 OS. The retinal arterioles appeared attenuated (Figures 1 and 2). Myopic scleral crescents were present bilaterally. No emboli were seen in either eye.

Red free imaging of the right fundus demonstrates arterial attenuation. No retinal emboli are seen.

Figure 2. Red free imaging of the right fundus demonstrates arterial attenuation. No retinal emboli are seen.

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