This is a 49 yo M who presented with acute 20/400 monocular vision loss and retinal whitening.
The OCT shows marked inner retinal hyperreflectivity from the acute ischemia, with pseudo-edema of the outer retina due to decreased transmission of light through the inner opaque retina.
The outer retina is still receiving oxygen from the choroid, as evidenced by sparing of the fovea (the yellow xanthophyll is prominently seen).
Learning Points:
This patient was sent to the emergency room for a stroke protocol workup (including electrocardiography, MRI, carotid non-invasive, cardiac echography, hypercoagulable labs, and inflammatory labs). The evaluation was totally negative.
This case looks very similar to gentamicin retinal toxicity. Intravitreal gentamicin can cause severe macular ischemic retinal necrosis. The macular capillaries have a characteristic cut-off appearance, as is seen in our patient who had no gentamicin exposure.
