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Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.

On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.

A dilated fundus examination was performed demonstrating the following:

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Retina

Case 23

Patient Presentation: You are seeing this patient for his annual eye examination and you are reviewing his OCT macula scan (shown below):

Question: What type of OCT protocol is shown on the left?

D. Macular thickness map

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E. OCT Angiography

A line scanning ophthalmoscope (LSO) fundus photo accompanies the OCT macula print out. This is useful because you can correlate any pathology seen on the OCT macula with the fundus photograph. An example of this is shown below:

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Question: What is the diagnosis highlighted by the red box?

A. Optic Nerve Drusen

B. Optic Pit Maculopathy

C. Peri-papillary Atrophy

D. Sclero-choroidal Calcifications

E. Retinal Detachment

Question: Based on the above OCT macula, the patient is likely an:

B. Axial hyperope

C. Axial emmetrope

Learning Objectives:

1. Recognize the OCT features of peri-papillary atrophy

2. Understand the importance of wide-field OCT imaging to make the diagnosis of posterior staphyloma

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