Blog

This patient had a uveal melanoma previously treated with plaque radiotherapy. Although the tumor was destroyed, retinal capillary damage created ischemic regions and secondary retinal neovascularization. The tumor diffusely stains on fluorescein angiography. Although scatter laser successfully caused the neovascularization to regress, residual areas of nonperfusion remain. Learning Points: Retinal neovascularization, which develops at the… Read More

Glistening crystals in the posterior pole are prevalent in this intravenous drug user with talc retinopathy. There is also a large fibrosed area of neovascularization along the border between the perfused retina to the right and the ischemic retina to the left, a neovascularization pattern somewhat similar to that seen in Eale’s disease. Learning Points:… Read More

Eale’s disease is our best guess for this 44YO male patient. Eale’s disease is characterized by peripheral, sharply circumscribed regions of ischemia. Fluorescein angiogram demonstrates leakage of retinal vessels at the junction of perfused and ischemic retina. For now, we are carefully observing the ischemic retina, but we will treat this region with scatter laser… Read More

This patient, previously treated for proliferative diabetic retinopathy with panretinal photocoagulation (PRP), presented with an asymptomatic resolving two-toned subhyaloid hemorrhage. The devitalized yellow blood indicates chronicity, although some red blood remains. The OCT confirms the subhyaloid location of the hyperreflective blood. Red blood is dark on fundus autofluorescence (FAF), although yellow blood is extremely hyperautofluorescent…. Read More

This 76YO male presented with 20/200 vision, the presence of an afferent pupillary defect, and extensive retinal hemorrhages. He had an acute ischemic central retinal vein occlusion (CRVO) with macular edema. Patients with CRVO are at risk of vision loss due to macular edema or anterior segment neovascularization. Macular edema is common in both non-ischemic… Read More

This 65YO female has a fresh peripheral subretinal hemorrhage. The subretinal blood often regresses spontaneously, as occurred in this patient (later images not shown). Learning Points: Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is essentially choroidal neovascularization occurring in the retinal periphery. PEHCR can be mistaken for uveal melanoma because the dark subretinal blood can simulate a… Read More

This patient with retinitis pigmentosa (RP) surprisingly has good central vision 20/30 OU. The fundus photos show all the classic findings for RP, including attenuated retinal vessels, extensive bone spicules (intraretinal migration of the RPE along retinal capillaries), and optic disc pallor. Fundus autofluorescence for this patient shows a ring of hyperautofluorescence around each central… Read More

This patient has an acute, macula-off retinal detachment with a large cilioretinal artery. Learning Points: Cilioretinal arteries arise from the choroidal circulation. This results in cilioretinal sparing with central retinal artery occlusion. Unfortunately, this vessel offers no visual protection against retinal detachment!

This patient has a large subretinal fibrotic disciform scar from end-stage wet age-related macular degeneration. OCT shows marked overlying retinal disorganization and cystic changes. Learning Points: These fibrotic scars are usually the result of untreated macular neovascularization. These were more the rule than the exception prior to the introduction of anti-VEGF therapy in the mid-2000’s…. Read More

Our patient presented in 1995 with classic active CMV retinitis involving the peripapillary and macular regions of his left eye. We immediately referred him to the University of Kentucky for implantation of a then-investigational sustained-release ganciclovir implant, Vitrasert. Note the hemorrhagic, whitish retinal necrosis, which often follows a vascular distribution. The retinitis spreads outwards, leaving… Read More