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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 53

Patient Presentation: An 82-year-old female with a past medical history of coronary artery disease, hypertension, osteoporosis and rheumatoid arthritis presents with decreased vision and metamorphopsia in her right eye. Visual acuity is 20/50 OD and 20/30 OS. IOP is stable OU. Unremarkable anterior segment examination. The patient’s OCT macula OD is shown below.

Retina 53-1.png

Question: Which of the following is visualized on the patient’s OCT macula OD?

A. Sub-retinal fluid

B. Intra-retinal cysts

C. Vitreomacular traction

D. All of the above

Question: What is the threshold diameter size used to classify VMT into focal or broad?

Retina 53-3.png

Question: The patient returns 4 months later, and a repeat OCT macula OD is performed which is shown above. Which of the following do you see on the OCT macula OD above?

A. Hyper-reflective layer on the inner retina

B. Sub-retinal fluid

C. Disruption of the foveal contour

D. All of the above

Retina 53-5.png

Question: Which of the following should you consider if the patient’s VMT is not released spontaneously?

A. Intravitreal ocriplasmin injection

B. Vitrectomy with inner limiting membrane peeling

C. Vitrectomy without inner limiting membrane peeling

D. Intravitreal perfluorocarbon injection

Learning Objectives:

To recognize the association of epiretinal membranes and vitreomacular traction syndrome.
To recognize the role of OCT in diagnosis and monitoring of vitreoretinal traction syndrome.

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