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 74
Patient Presentation: A 78-year-old man was referred to a tertiary retina clinic for decreased vision OS. The patient denied red eye, flashes, floaters, scalp tenderness, or jaw claudication. He had a 40-pack year smoking history. Ocular history was significant for cataract extraction OU and dry AMD, which was monitored by his optometrist.
His visual acuity was 20/25 OD and 20/100 OS. There was no RAPD. IOP was within normal limits. Anterior segment examination was unremarkable. Fundus examination demonstrated numerous medium – large sized drusen OU with no sign of hemorrhage.
OCT macula images were taken and shown below:
Question 1: Describe the main findings in left eye OCT macula image above?
Question 2: What is the main finding in the OCT above?
Question 3: What is the risk of treating these patients with anti-VEGF injections?
References:
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Mukai R, Sato T, Kishi S. A hyporeflective space between hyperreflective materials in pigment epithelial detachment and Bruch’s membrane in neovascular age-related macular degeneration. BMC Ophthalmol. 2014;14:159. doi:10.1186/1471-2415-14-159
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Kim JH, Chang YS, Kim JW, Kim CG, Lee DW. Prechoroidal Cleft in Type 3 Neovascularization: Incidence, Timing, and Its Association with Visual Outcome. J Ophthalmol. 2018;2018:2578349. doi:10.1155/2018/2578349
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Kim JH, Kim JW, Kim CG, Lee DW. LONG-TERM COURSE AND VISUAL OUTCOMES OF PRECHOROIDAL CLEFT IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION AND POLYPOIDAL CHOROIDAL VASCULOPATHY. Retina. 2021;41(12):2436-2445. doi:10.1097/IAE.0000000000003242
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Nagiel A, Freund KB, Spaide RF, Munch IC, Larsen M, Sarraf D. Mechanism of retinal pigment epithelium tear formation following intravitreal anti-vascular endothelial growth factor therapy revealed by spectral-domain optical coherence tomography. Am J Ophthalmol. 2013;156(5):981-988.e2. doi:10.1016/j.ajo.2013.06.024
Learning Objectives:
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To identify pre-choroidal clefts on OCT imaging.
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To recognize the significance of pre-choroidal clefts and risk of RPE tears with anti-VEGF treatment.