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Case 5

Patient Presentation: A 65-year-old male was referred for a 2-month history of acute, painless, vision loss OS. He denied any headaches, flashes or floaters. His past ocular history was significant for reduced visual acuity OD secondary to a myopic CNVM three years ago. His past medical history was significant for type II diabetes mellitus, hypertension and dyslipidemia; family history was non-contributory. His medications included metformin, perindopril and rosuvastatin. He had a 12-year smoking history. On examination, BCVA was 20/200 OD and 20/70 OS. There was no RAPD. IOP was normal. Dilated fundus exam was notable for 0.5+ vitreous cells OU.

Optos fundus photography and fundus autofluorescence were performed and shown below.

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Question: Describe the images

IVFA was subsequently performed demonstrating posterior pole arteriolar staining (red arrow) as shown in the left eye below. The rest of the IVFA was otherwise unremarkable.

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An OCT of the macula of the right and left eye was performed and shown below:

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Question: Describe the findings on the OCT

Question: Based on the clinical presentation and imaging findings, which of the following diagnoses is highest on your differential to account for the patient’s decrease in BCVA OU?

Question: On further history, the patient endorses weight loss over the past 6 months.  Review of systems is otherwise negative.  Based on your suspicion, which of the following is the most reasonable next step?

Question: Which of the following could be appropriate management options for this patient?

Learning Objectives:

1. Identify OCT features of cancer associated retinopathy

2. Recognize the role of other imaging modalities in conjunction with OCT in diagnosing cancer associated retinopathy

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