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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 32

Patient Presentation: A 68-year-old female with age-related macular degeneration is referred with gradual decreased vision. She was previously receiving anti-VEGF injections. The patient has no notable past medical or ocular history; Her vision is 20/25 OD and 20/400 OS. Her OS OCT macula is shown below

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Question: What abnormality is NOT visualized in the patient’s OCT image?

A. Hypo-reflectivity in outer nuclear layer

B. Loss of ellipsoid layer

C. Intraretinal and subretinal fluid

D. Subretinal hyper-reflective material

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Question: What structures are the yellow arrows pointing to?

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Question: What disease is commonly associated with outer retinal tubulations?

A. Open-angle glaucoma

B. Nuclear sclerotic cataracts

C. Neovascular AMD

D. Retinal detachment

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Question: What is the treatment of choice for outer retinal tubulations?

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Learning Objectives:

1. To diagnose and recognize outer retinal tubulations by their location in the outer nuclear layer, hyper-reflective demarcation, and association with chronic outer retinal degenerative conditions.

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