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This patient presented with very subtle retinal vascular telangiectasia in the temporal macula, some scattered temporal macular lipid, and moderate cystic retinal edema with trace subretinal fluid on OCT. There were also a few larger scattered deep retinal hemorrhages. Fluorescein angiography shows much more dramatic intraretinal vascular abnormalities centered in the temporal macula with moderate… Read More

This 28YO male presented with 20/60 vision after being hit the night before in the right eye with a Nerf arrow. Optos imaging shows outer retinal whitening and hemorrhages extending from the inferior macula into the inferotemporal periphery. Multiple ragged retinal breaks with a shallow retinal detachment are noted more peripherally. The patient was taken… Read More

This 62YO female presented with 20/30 vision from a symptomatic superior hemiretinal vein occlusion (HRVO). Fundus imaging shows moderate retinal hemorrhages in the superior retinal hemisphere and a prominent collateral vessel along the nasal aspect of the optic nerve. There is superior macular edema on OCT. Learning Points: Branch retinal vein occlusions (BRVO) are virtually… Read More

This 66YO male was examined following I-131 plaque radiotherapy and transpupillary thermotherapy for a type 1A, PRAME+ uveal malignant melanoma. Vision was 20/80, and the tumor was regressing compared to its preoperative appearance (not shown). He was getting intravitreal injections every 4 months as prophylaxis against radiation retinopathy. The patient returned 8 months later for… Read More

This 41YO female presented with vision of 20/70 OD and 20/25 OS from bilateral retinal vasculitis, highlighted well on fluorescein angiogram. Extensive workup was negative, including sarcoidosis (chest X-ray, ACE, lysozyme), ANCA, ANA, HLA-B27, Lyme, and RPR. Following the negative labs, she was started on oral prednisone 20mg/day. Learning Points: Idiopathic Retinitis, Vasculitis, Aneurysms, and… Read More

This 72YO male presented with marked macular edema and 20/150 vision from a nonischemic central retinal vein occlusion (CRVO). Four weeks later, following a single Lucentis injection, vision improved to 20/70, and the edema almost completely resolved. Although most patients respond favorably to anti-VEGF therapy, our patient’s dramatic, rapid improvement following a single injection is… Read More

This 13YO girl presented with headaches and tinnitus with 20/25 vision OU. There was moderate bilateral optic nerve swelling, beautifully imaged with Triton swept-source OCT. Visual fields showed enlarged blind spots. MRI scanning was normal, and her lumbar puncture had a severely elevated opening pressure of 49mm H2O, establishing the diagnosis of idiopathic intracranial hypertension… Read More

Despite full panretinal photocoagulation, this 57YO patient with proliferative diabetic retinopathy developed an acute premacular hemorrhage. Her vision was 20/300 in the right eye. Learning Points: Panretinal photocoagulation has been around since the 1960s and still remains the mainstay for treating proliferative disease. Often considered a “one and done,” patients can still develop breakthrough hemorrhages…. Read More

This patient presented with a sharply-circumscribed macular serous detachment, cystic outer retinal edema, and an outer macular hole. Fluorescein angiography is essentially normal without leakage. An optic pit was absent clinically and on OCT imaging. Serum protein electrophoresis was normal, and a systemic cancer workup was negative. Learning Points: Serous detachment can be an uncommon… Read More

Our patient presented with a focal, creamy-white inflammatory lesion obscured by dense vitritis. Vision was 20/80. Interestingly, he gave a history of chickenpox five months earlier, which coincided with his visual symptoms. Observation was recommended since he felt that his vision was improving. Two months later, the vitritis had improved, and the inflammatory lesion had… Read More