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Case 9

Contributor: Eli Kisilevsky MD

Patient Presentation: A 26 year-old previously healthy female presented to ophthalmology clinic with a 3 day history of a central scotoma in the left eye. She endorsed influenza-like symptoms one week prior to presentation. She denied history of sun-gazing. Her review of symptoms was otherwise unremarkable. Uncorrected visual acuity was 20/20 and 20/30 with normal pupils and IOP. Slit lamp examination was unremarkable with no evidence of anterior chamber inflammation. Dilated fundus examination revealed the following:


Question: Describe the image

An OCT of the macula was performed to further evaluate the abnormality:

Question: Based on the fundus images, which of the following is on your differential?


Question: What layer of the retina is disrupted in the OCT of the left eye?

Intravenous fluorescein angiogram was then performed:


Question: Describe this image

Question: Based on the history, examination, and imaging findings, what is the most likely diagnosis?

Question: What would you do next?

The patient was observed:

Follow-up OCT (1 month later)


Follow-up OCT (2 months later)

Serial OCT examination demonstrating resolution of the dome shaped lesion but some irregularity of the interdigitation zone remained. Vision improved to 20/20 at last follow up.


Learning Objectives:

1.    Describe findings of ARPE on OCT 
2.    Differentiate ARPE from other idiopathic maculopathies based on OCT and IVFA. 

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