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This 40YO male presented with sudden vision loss in his left eye. Vision was 20/200 OS and 20/20 in his normal right eye. Fundus photo shows a large subhyaloid hemorrhage covering the macula, vitreous hemorrhage extending inferiorly, and some scattered deep retinal hemorrhages. Fluorescein angiography shows no leakage or source for the blood. Blood pressure… Read More

This patient presented with counting-finger vision from an acute hemorrhagic central retinal vein occlusion (CRVO) with marked macular edema. The poor vision and extensive retinal hemorrhages suggest that this is an ischemic CRVO. After five monthly anti-VEGF injections, vision improved to 20/50, the retinal hemorrhages resolved dramatically, optic disc collaterals formed, and OCT showed complete… Read More

Is that another optic nerve? This is a pseudo-duplicated optic disc from peripheral neovascularization emanating from a disc-sized mid-peripheral chorioretinal scar. The OCT reveals the area of choriovitreal neovascularization. Learning Points: The neovascularization regressed following panretinal photocoagulation (PRP) supplemented with intravitreal Eylea injections. Fluorescein angiography following PRP and anti-VEGF injections shows virtually no leakage from… Read More

This 25yo was referred for this asymptomatic choroidal coloboma. A B-scan OCT through our patient’s coloboma shows that the sclera is continuous and non-displaced within the coloboma. A staphyloma, by definition, is an outpouching of the entire eye wall. Choroidal coloboma always involves a choroidal defect, but may or may not also involve the sclera…. Read More

This 70YO male presented with this nasal choroidal nevus. Other than being near the optic nerve, our patient has none of the risk factors for transformation to uveal melanoma. The presence of drusen also indicates chronicity and low risk for malignant transformation. We are following him yearly. Learning Points: Clinical characteristics of choroidal nevi at… Read More

This patient with age-related macular degeneration (AMD) has a large fibrotic disciform scar in the right eye and dry AMD in the left eye with macular atrophy skirting the foveal center and more distal calcified drusen. The coarse pigmentary changes noted inferiorly and temporally in the right eye are a classic tell-tale finding for prior… Read More

This 44YO male presented with 20/60 vision in his right eye. The left eye was normal with 20/20 vision. His fluorescein angiogram (FA) shows classic findings for idiopathic central serous chorioretinopathy (ICSC). There is the more common blot leak, as well as the classic “smokestack” leak, which occurs in only about 10% of cases. The… Read More

This patient presented with a posterior pole vitreous hemorrhage OD and localized subhyaloid hemorrhages OS. The OCT of the right eye highlights a thickened hyaloid on either side of the fovea with specks of hyperreflective pre-retinal blood. The left eye shows the subhyaloid blood blocking most of the underlying retinal detail. This patient has already… Read More

This is a classic case of cystoid macular edema (CME) following cataract surgery, otherwise known as the Irvine-Gass Syndrome. The decompensated inner blood retinal barrier of the perifoveal capillaries allows fluid to leak into the surrounding outer plexiform (Henle’s) layer, causing the classic radiating petaloid pooling on fluorescein angiography. OCT shows intraretinal edema with cystic… Read More

Our best guess is that this patient has a choroidal osteoma. As choroidal lesions, they are best seen on the Optos red channel. We would, however, expect more reflectivity on the B-scan as osteomas are typically markedly hyperreflective. Learning Points: Choroidal osteomas are benign, calcified amelanotic choroidal tumors. They are more common in women, are… Read More