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Grouped-type congenital pigmented nevi of the retinal pigment epithelium (RPE) or bear tracks is a rare congenital condition characterized by well-demarcated, hyperpigmented, flat, variably-sized RPE lesions, resembling bear footprints. Histopathologically, these lesions are similar to congenital hypertrophy of the RPE (CHRPE), with an increased number of pigment granules in normal-sized RPE cells. These lesions are… Read More

This asymptomatic 10YO boy presented with 20/40 vision OD and 20/20 vision OS. There were multifocal small subretinal pigment clumps with surrounding pigment loss in the right central macula. OCT shows foveal outer segment loss with ragged RPE loss. The left macula was normal. He denied looking at a laser pointer but did admit to… Read More

This patient has a large choroidal coloboma extending through the left optic nerve and macula. It’s so extensive that it hides the optic nerve. These arise from incomplete closure of the embryonic fissure during the second month of embryonic development. Patients are at lifelong risk for rhegmatogenous retinal detachment due to breaks that occur in… Read More

Although this diabetic patient had normal vision with absolutely no symptoms, what we saw on clinical examination and Optos color imaging was nothing but asteroid hyalosis. Fluorescein angiography (FA) showed bilateral proliferative diabetic retinopathy with areas of leakage and peripheral capillary dropout. In-office panretinal photocoagulation (PRP) was not possible due to the dense asteroid. We… Read More

At first or quick glance, this looks like an old inferotemporal branch retinal vein occlusion (BRVO). On closer inspection, there is a white-sheathed vessel arising from the nerve inferiorly. Numerous collateral vessels are noted inferior and temporal to the fovea, and there is a sheathed vessel in the inferior arcade. OCT shows marked inner retinal… Read More

Our highly myopic patient has a fairly symmetrical bilateral posterior staphyloma that encircles each optic nerve and macula. Vision is counting fingers OD and 20/50 OS. OCT demonstrates steep scleral curvature and outpouching. Learning Points: Posterior staphyloma is a weakening, thinning, and outpouching of the sclera most commonly seen in degenerative myopia. See Moriyama et… Read More

This patient was being followed for an inactive nasal macular chorioretinal scar with 20/25 vision. After being lost to follow-up for many months, he presented with counting-finger vision from an active type 1 macular neovascularization. The macular OCT shows a complex lesion with the MNV located primarily beneath the RPE. The lipid precipitated out in… Read More

This 22YO female presented with 1 week of unilateral vision loss and 20/200 vision in her right eye. The macular OCT line scan demonstrates a bacillary layer (cone and rod inner and outer segments) detachment. This appears as a unique dome shaped collection of intraretinal fluid from photoreceptor myoid splitting. Six weeks later vision improved… Read More

This patient is a 28YO who presented with hand motion vision from an acute central retinal vein occlusion (CRVO). The poor vision and extent of retinal hemorrhages would suggest an ischemic occlusion. However, fluorescein angiography shows good peripheral perfusion, indicating a non-ischemic CRVO. Angiography also shows marked foveal hypofluorescence, which may be due to a… Read More

This patient experienced some superior visual field loss following cataract surgery. A stagnant blob of triamcinolone-moxifloxacin accumulated in the subhyaloid space in the inferior macula. The medication eventually dissolved as the patient’s symptoms resolved. Learning Points: TriMoxi is commonly used in dropless cataract surgery, so patients don’t need to use postoperative antibiotic and steroid drops…. Read More