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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.

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Case 56

Figure 1.

Author: Amy Pai     Editor: Adrian Fung

A 66-year-old Caucasian lady presented to her local ophthalmologist complaining of a 2 months history of blurry vision in her right eye.

Case history

A 66-year-old Caucasian lady presented to her local ophthalmologist complaining of a 2 months history of blurry vision in her right eye. She was diagnosed with right peri-papillary CNVM a year ago and treated with six Bevacizumab injections to date. They were started at one monthly intervals and now given on a PRN basis. She was referred to us for a second opinion and the treating ophthalmologist has noticed bilateral vitreous cells recently. She denied any other previous eye issues or operations and only takes an antihypertensive normally. She denied smoking and there is no family history of ocular problems. She normally wears glasses for reading.

Visual acuity was 6/18 (pinhole no improvement) in the right eye (OD) and 6/6 in the left eye (OS). Mild nuclear sclerotic cataracts were present in both eyes. There was no anterior chamber cells, flare, or posterior synechiae. Pupil reaction was within normal with no RAPD present. Pigmentary changes were noted in the right peri-papillary region and there was also an area of pigmentary change inferotemporal to the fovea. (Figure 1 shows the right fundus, the view was hazy due to vitritis). There were also irregularities in the retinal vessels, suggestive of vasculitis. The optic disc was full in appearance but with clear margins. Figure 2 shows the left fundus, there were also some RPE changes within the posterior pole, as well as similar vessel appearance suggestive of retinal vasculitis. The view is also hazy due to vitreous activity.

Optical coherence tomography shows multiple bilateral exudative retinal detachments, outer retinal cysts and thickened choroids.

Figure 2. RPE changes in the macular region with irregular vasculature suggestive of vasculitis.

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