2/1/2017
1
VRS Meeting 2017
16 yo girl
Decrease in vision gradually OS over the last year
Va 20/20 OD, 20/70 OS
SLE normal OU
Fundus OD Avascular temporally with dot heme
PMHx- Negative per the patient
Fundus OS
OCT Surgery
Vitrectomy, Membrane Stripping, Laser, AFX OS
Mother: Patient was born at 26 weeks,monitored for ROP, but no treatment required or given
2/1/2017
2
Adult ROP after PPV Va 20/40+
Adult ROP
Patients premature with low birth weights, don’t receive treatment as an infant
Later in life prone to RD, vitreous hemorrhage or tractional ERM
Mean age 22, but majority 8-20 years old
Good success with PPV and or SB if membranes are not severe
61 yo Male
Slight decrease in peripheral vision OD
Told he had retinoschisis
PMHx Sleep Apnea
VA 20/20 OD, 20/20 OS
IOP 15,16
SLE normal OD/OS
Fundus normal OS
Fundus OD FA
2/1/2017
3
OCT OCT of lesion
Diagnosis/Management Choroidal Hemangioma
Average age at diagnosis is >50 Peripapillary or macular location common Serous detachment surrounding the lesion
causes the initial visual symptoms If treatment is required
Laser Photodynamic Therapy
Diffuse form seen in Sturge-Weber syndrome (Nevus flammeus, glaucoma, seizures, etc)
Sometimes called choroidal cavernous hemangioma
67 yo 20/25 vision 17 yo Male
Slight decrease in vision OD, of unclear duration, maybe just since his exam
Told he had a BRVO
Va 20/30 OD, 20/20 OS IOP NL OU SLE NL OU Fundus Normal OS PMH negative
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4
Fundus OD Diagnosis/ Management
Retinal Cavernous Hemangioma
Saccular aneurysms filled with dark venous blood, “cluster of grapes”projecting from the inner retinal surface
Average age at diagnosis 23
Most sporadic, but rare neurocutaneous syndrome with optic nerve, optic tract and brain lesions
Observation unless recurrent VH
52 yo female Sent for a retinal detachment OD, same day surgery
Symptoms for 2 years PMHx Factor II Clotting Disorder, Thyroid Disease,
Asthma, Endometriosis, Hypertension
Va 20/50 OD, 20/20 OS IOP NL OU SLE NL OU Fundus NL OS
Fundus OD
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5
Diagnosis/Management? Coats’ disease Atypical presentation Young males, less than 10% females Peripheral exudation can be severe and
asymptomatic Treatment can cause severe CME Multiple treatment modalities required
Anti-vegf IOS Laser Cryo
Caution with PPV
After IOS (1)/Avastin (5)/laser (2) Va 20/20 after CE OD
64 yo Male
Decrease in central OS vision over three days
No pain, photophobia, flashes or floaters
Rash over his upper body and arthralgias of knees, shoulders and back over the last ten days
Past Medical HX
Cholecystectomy
Fish oil, Multivitamin
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6
Exam
Va 20/20 OD, 3/200 OS
IOP 19 OD, 23 OS
Ant Seg normal OU
Fundus OD
Fundus OS
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7
Questions? 2 weeks later, 20/100
6 weeks later, 20/20
Additional history
Had returned 10 days prior from a two week mission trip in Haiti
UAIM
Working diagnosis
Lab work up (negative) Coxsackie A and B
Lyme
RPR
TB skin test
CBC with diff
CDC testing for Dengue IgG positive, IgM negative
2/1/2017
8
Plaque reduction neutralization Technique Due to time lapse between symptoms and
presentation PCR was not thought to be useful. CDC recommended a PRNT due to possible cross reactivity between flaviviruses Zika virus positive
Dengue and Chikungunya were negative
Counseled to avoid unprotected sex with women of child bearing age for 6 months
Zika Virus Arbovirus in the flavivirus family (dengue,
chickungunya) Uganda 1947
Fever, arthralgias and rash 2007 became more widespread, early
cases associated with Guillain- Barre 2015- start of epidemic in Brazil Transmission by mosquito Aedes aegypti
and sexual intercourse
Congenital findings
Microcephaly
Macular atrophy
Chorioretinal scars
Optic nerve anomalies
16 year old
Healthy male, sudden vision loss OD 20/30 OD, 20/20 OS
2/1/2017
9
History
Blue laser 1 Watt exposure from 10 feet away to right eye prior to vision loss
20 yo blue laser injury, 1 W Laser injury
11 yo OD, 20/60 11 yo OS 20/150
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10
11 yo, Bilateral Red Laser Thank You
2007, 41 yo female 2008
2010 2012
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11
2013 2014
2016, Va 20/100 October 2016
Sudden vision loss in new area
Va 20/20 OD, 20/150 OS
IOP NL OU
SLE NL OU
Fundus OD normal
Fundus OS Mild Vit Cell
November 2016
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12
December 2016, Va 20/80 Outer Retinal Toxoplasmosis
Classic toxoplasmosis Full thickness retinal involvement and
severe vitritis (headlight in the fog)
Deep or outer retinal toxo Deep retinal whitening with little or no vitritis
IgG and IgM positive for toxo Therapy can limit atrophy?
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