Neuro-Ophthalmology

Case 15

Patient Presentation: A 49-year-old male was referred to ophthalmology for evaluation of possible macular edema. He has a history of secondary progressive multiple sclerosis (MS) diagnosed in 1993 and has a remote history of optic neuritis in both eyes. His neurologist is planning on starting a new medication for MS and macular edema is considered a contraindication. A referral is sent to ophthalmology to rule out macular edema.

Question: Which of the following medications has NOT been linked with the development of macular edema?

Neuro-Ophthalmology 15-1.png

Question: An OCT macula was performed in both eyes, which was normal in the right eye. The OCT macula of the left eye is shown above. Which layer of the retina is the yellow arrow pointing to?

Neuro-Ophthalmology 15-2.png

Question: What is the most notable abnormality in the OCT macula above?

Neuro-Ophthalmology 15-3.png

Question: An OCT RNFL (shown above) was performed demonstrating optic atrophy OU secondary to previous episodes of optic neuritis. On further history, the patient does not endorse any change in vision. Based on this information, what is the most likely diagnosis?

Reference:

Lujan BJ, Horton JC. Microcysts in the inner nuclear layer from optic atrophy are caused by retrograde trans-synaptic degeneration combined with vitreous traction on the retinal surface. Brain. 2013 Nov 1;136(11):e260.

Learning Objectives:

1. To review common medications associated with drug induced cystoid macular edema

2. To describe macular OCT findings in patients with optic atrophy