Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.
On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.
A dilated fundus examination was performed demonstrating the following:
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Retina
Case 63
Contributors: Marko Tien (Medical Student) and Dr. Amrit Rai
Patient Presentation: An 11-year-old male was referred to ophthalmology for an abnormal retinal lesion in the left eye. The patient is asymptomatic. Visual fields are normal, and BCVA is 20/20 OU. Fundus exam was performed and is shown below:
Question: What is the abnormality seen in the OCT?
Question: Based on the imaging and exam findings, what is the most likely diagnosis?
Question: What is the prognosis of a patient who presents with dark-without-pressure lesions?
References:
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Fawzi, A. A., Nielsen, J. S., Mateo-Montoya, A., Somkijrungroj, T., Li, H. K., Gonzales, J., Mauget-Faÿsse, M., & Jampol, L. M. (2014). Multimodal imaging of white and dark without pressure fundus lesions. Retina (Philadelphia, Pa.), 34(12), 2376–2387. https://doi.org/10.1097/IAE.0000000000000388
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Flores Pimentel, M.A., Duncan, J.L., de Alba Campomanes, A.G. et al. (2021). Dark without pressure retinal changes in a paediatric age group. Eye 35, 1221–1227. https://doi.org/10.1038/s41433-020-1088-5
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Gupta, Gaurav & Bajgai, Priya & Singh, Ramandeep. (2018). Dark-Without-Pressure Fundus Lesions.
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Nagpal, K. C., Goldberg, M. F., Asdourian, G., Goldbaum, M., & Huamonte, F. (1975). Dark-without-pressure fundus lesions. The British journal of ophthalmology, 59(9), 476–479. https://doi.org/10.1136/bjo.59.9.476
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Rafieetary, M. (Feb 2021). Navigating the Retinal Periphery. Review of optometry (eJournal). Accessed on Nov 12, 2021: https://www.reviewofoptometry.com/article/navigating-the-retinal-periphery
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Strohbehn A. Sohn EH. Retinal Detachment: From One Medical Student to Another. EyeRounds.org. October 15, 2013; available from http://EyeRounds.org/tutorials/retinal-detachment-med-students
Learning Objectives:
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Identify the funduscopic presentation and OCT findings of dark-without-pressure lesions.
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Understand the clinical significance and prognosis of dark-without-pressure lesions