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This patient has morning glory syndrome, and the left optic nerve appears to have large optic disc excavation with radial vessels, central glial tissue and peripapillary atrophy and pigmentation. Visual prognosis is usually poor. Learning Points: The morning glory syndrome is typically unilateral and shares some similarities with optic disc coloboma and juxtapapillary staphyloma. The… Read More

Multifocal images of an extramacular epiretinal membranes with an unrelated temporal retinal pigmented epithelial detachment are displayed here (Optos, red-free, and fluoroscein angiography). BONUS: The second set of images is a different patient with a macular pucker that is well-visualized using OCT en face analysis, which provides transverse views of the retinal and choroidal layers… Read More

This patient’s symptomatic 20/80 vitreomacular traction was treated with pneumatic vitreolysis, where a small gas bubble was injected into the vitreous cavity to induce a posterior vitreous detachment. The patient wished to try this less invasive option instead of vitrectomy. Although the traction successfully released 1 week postop, the patient developed an immediate macular hole… Read More

This patient has an uncommon pancreatic choroidal metastasis. The lesion is clinically amelanotic with a more central area of increased pigmentation but is much larger on fundus autofluorescence. The OCT shows marked choroidal thickening with some subretinal fluid. Fluoroscein angiography (FA) shows no leakage with blockage from the central hyperpigmentation and fainter surrounding blockage from… Read More

This is a patient with uveal melanoma treated with a radiation plaque therapy 8 years ago. Widefield fundus autofluorescence helps us image these clinically subtle RPE findings better than ever before. Learning Points: When active, these lesions can chronically leak causing disruption in the RPE with a “gutter”. Gutters are commonly seen in pathology with… Read More

This patient with proliferative diabetic retinopathy has a dense subhyaloid hemorrhage. The yellowing subhyaloid blood indicates that this has been present for at least several months. The OCT highlights the subhyaloid hemorrhage that blocks all underlying retinal detail and the hyper-reflective vitreous red blood cells gives a “snowy” appearance.

This patient has a large serous retinal detachment from idiopathic central serous chororetinopathy (ICSC). OCT demonstrates the serous retinal detachment and a pigment epithelial detachment. The late phase fluorescein angiography hows classic “smokestack” leakage. Learning Points: ICSC is part of a larger spectrum of pachychoroid diseases. Pachychoroid, meaning “thick” choroid, is secondary to large dilated… Read More

This patient presented with a new retinal tear causing retinal detachment in an eye with previously lasered operculated hole. Learning Points: The normal neurosensory retina remains attached to the RPE due to numerous physiologic mechanisms including the the inner (retinal vascular endothelium) and outer (tight junctions at the apex of the RPE cells) blood retinal… Read More

This patient had papilledema with severe disc hemorhages. MRI detected a compressive meningioma as the cause for the elevated intracranial pressure. Learning Points: Optic nerve swelling has numerous causes, including neurologic (optic neuritis and elevated intracranial pressure) and retinal (retinal vein occlusion, neuroretinitis, sarcoidosis, Harada’s) causes. Bilateral optic nerve swelling due to elevated intracranial pressure… Read More

This patient with a history of involuted proliferative diabetic retinopathy following complete panretinal photocoagulation presented with what appeared on OCT to be new diabetic macular edema. A closer inspection of the B-scan shows the retina to be normal with the pseudo-edema representing subhyaloid blood.