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 66
Patient Presentation: A 71-year-old male presented to a tertiary retina clinic to monitor his epiretinal membrane. Vision was 20/20 in both eyes, and he denied any recent visual changes.
An OCT of the right eye is displayed below.
Question: Based on the OCT image, what condition does this patient have in his right eye?
Question: Based on the OCT findings earlier, which of these conditions is this patient at risk of developing?
The patient was seen one year later and continued to not have any symptoms. Their OCT is shown below.
Question: What retinal changes do you note at this visit compared to the last OCT?
6 months later, the patient presented with a one-week history of blurred vision in his right eye. An OCT of his right eye was performed and shown below:
Question: What retinal changes do you note at this visit?
References:
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Romano MR, Comune C, Ferrara M, Cennamo G, De Cillà S, Toto L, et al. Retinal Changes Induced by Epiretinal Tangential Forces. Journal of Ophthalmology. 2015;2015:1–13.
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Duker JS, Kaiser PK, Binder S, de Smet MD, Gaudric A, Reichel E, et al. The International Vitreomacular Traction Study Group Classification of Vitreomacular Adhesion, Traction, and Macular Hole. Ophthalmology. 2013 Dec;120(12):2611–9.
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La Cour M, Friis J. Macular holes: classification, epidemiology, natural history and treatment: Acta Ophthalmologica Scandinavica 2002. Acta Ophthalmologica Scandinavica. 2002 Dec;80(6):579–87.
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Tsai C-Y, Hsieh Y-T, Yang C-M. EPIRETINAL MEMBRANE–INDUCED FULL-THICKNESS MACULAR HOLES: The Clinical Features and Surgical Outcomes. Retina. 2016 Sep;36(9):1679–87.
Learning Objectives:
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Create a basic differential for a full thickness macular hole
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Identify and diagnose an epiretinal membrane, detached posterior hyaloid, and full thickness macular hole on OCT
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Recognize a possible etiology of a full thickness macular hole