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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 80

Contributor: Julia Di Ianni, COMT

Patient presentation: A 28-year-old female was referred to a tertiary retina clinic by her optometrist following a routine eye examination, which found a suspicious retinal lesion OD. The patient was asymptomatic. With spectacle correction of -2.25D OD and -2.75D OS, her best-corrected visual acuity was 20/20 OU. Anterior segment examination was unremarkable. Fundus examination of the left eye was unremarkable. Widefield fundus photograph and fundus autofluorescence images of the right eye were obtained and are shown below:

Question 1: What are the key findings on the fundus photograph and FAF images above?

SD-OCT macula images of both eyes were taken and are shown below:

B. Rim of chorioretinal atrophy

A. Focal, circular, elevated lesion

C. Hypoautofluorescent lesion with rim of hyperAF

D. All of the above

A skillful technician was able to take an OCT 5-line raster scan over the lesion:

Question 2: What are the key features on the OCT imaging?

A. Intraretinal hyper-reflective elevated lesion

B. Subretinal fluid

C. Cystoid intraretinal fluid

D. Intraretinal hamartoma

Question 3: Based on all the relevant ocular imaging, what is the most likely diagnosis?

A. Horseshoe tear

B. Cystic retinal tuft

C. Amelanotic congenital hypertrophy of the retinal pigment epithelium (CHRPE)

D. Astrocytic hamartoma

Question 4: What is the treatment?

Click Here For Answer

References:

Patel SJ, Feldman BH, Phelps P, Miller AM, Barash A, Murchison A, Justin GA, Tsui JC, Bhagat N, Lim JI, Lai KE, Karth PA, Gullapalli V, Starr M. (2024). Retinal Detachment. EyeWiki. Retrieved from https://eyewiki.org/Retinal_Detachment

Learning Objectives:

OCT imaging of the peripheral retina offers high-resolution, cross-sectional anatomical detail of subtle lesions and can play a significant role in guiding clinical decision-making.

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