Case 33

Patient Presentation: A 56-year-old male presented to the eye clinic with acute onset of metamorphopsia x 3 days in the left eye. His past ocular history is significant for myopia. He was seen 7 months prior in eye clinic and had a stable eye examination. On examination today, his vision was 20/200 in the left eye compared to 20/60 at his last eye examination 7 months prior. There was no RAPD. His slit lamp examination demonstrated mild nuclear sclerosis. Fundus examination demonstrated a myopic fundus with no obvious new changes in the macula. An OCT macula was performed today and compared with the OCT seven months ago. 

HD 5 Line Raster: Today

HD 5 Line Raster: 7 Months Ago

Question: Based on the serial OCT scans shown, what is the most noticeable change between the scans?

Question: The macula of the left eye is seen below in the SLO image (A) with the corresponding horizontal OCT section (B). What does the image below highlight?

Question: Given the acute change in vision, what investigation should be performed next?

Question: While scrolling through the scans in the macular cube protocol, the following OCT image (left) is seen. What is the diagnosis?

Recall that in contrast to a macular pseudohole, a FTMH involves the full thickness of the retina.

Learning Objectives:

1. Review the OCT findings seen in a posterior staphyloma

2. Understand the shortcomings of the raster protocol

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