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Case Presentation

Case Presentation. 1.3.2002 SINGLETON HOSPITAL. History. GP referral RE visual loss R 9/6 L6/6 ?RP 16.11.01 54yr old myopic Caucasian male 2/7 distorted vision POH Myope since childhood PMH unremarkable. 16.11.01. No medical Treatment Penicillin Allergy FH Mother had cataract.

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Case Presentation

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  1. Case Presentation 1.3.2002 SINGLETON HOSPITAL

  2. History GP referral RE visual loss R 9/6 L6/6 ?RP 16.11.01 • 54yr old myopic Caucasian male • 2/7 distorted vision • POH Myope since childhood • PMH unremarkable

  3. 16.11.01 • No medical Treatment • Penicillin Allergy • FH Mother had cataract

  4. 16.11.01 • VA R 6/6 L 6/5 • Near R N/10 L N/5 (distorted) • Normal Anterior Segment • Posterior segment • lytic lesions, distributed in peripapillary • foveal fluid & marginal hg

  5. 16.11.01 • DD • Old /new CSCR • central CNVM 2 to ?POHS • FFA on 28.11.01

  6. Differential Diagnosis • Myopic degeneration • MIC (multifocal inner choroidopathy) • PIC (punctate inner choroidopathy) • POHS (Presumed ocular histoplasmosis syndrome) • Idiopathic CNVM

  7. Differential Diagnosis • Birdshot Chorioretinopathy • APMPPE (acute posterior multiple placoid pigment epitheliopathy)

  8. MIC • Age: 20 - 50 yrs • F:M 3:1 • Young healthy moderately myope • C/O • Subacute blurred vision • Floaters

  9. MIC Examination • 50% - AAU • Vitritis + multiple grey -white/ yellow lesions at RPE/ inner choroid • New lesions & recurrences occur Prognosis Fair • Visual loss: CMO/CNVM Treatment • Periocular steroid

  10. PIC • Young healthy myope • Commoner in female • Unknown etiology • C/O • acute decreased VA/ central Scotoma

  11. PIC • Exam • Quiet Anterior segment • Multiple white/yellow lesion in peripapillary region/ fovea in RPE/IC level +/- serous elevation of NSR • No vitritis • 1/3 rd develop CNVM • Prognosis Good • Treatment Controversial • Steroid • Submacular surgery

  12. POHS • Endemic area of Ohio-Missisipi river valley • Exam • Histo spots • atrophic punched out lesions around the disc • maculopathy : pigment ring with overlying NSR det. • Maculopathy develops in 2nd decade • NO vitritis

  13. POHS • Treatment • early stages: steroids • CNVM: Photocoagulation/ Submacular sx • Prognosis Variable • Without treatment 59% with VA worse than 6/60 • Histo spots in macular area 25% chance of attack over next 3yrs • No spots in macular area 2% chance of attack

  14. Birdshot chorioretinopathy • Uncommon • F>M past 4th decade • HLA- A29 (50-80%) • C/O • Reduced VA, nyctalopia • Colour VA disturbed

  15. Birdshot chorioretinopathy • Exam • Minimal/No Anterior segment inflamm • Cream coloured depigmented spots throughout fundus (birdshot from a shotgun) • attenuated & sheathed vessel, disc oedema, OA • CMO • Reduced ERG • Treatment • Periocular / systemic steroids

  16. APMPPE • Young adults • F:M 1:1 • Assoc. HLA DR2 & HLA B7 • C/O • Unilateral visual loss • prodromal flu-like symptomps 50% • few has CNS vasculitis

  17. APMPPE • Exam • Deep placoid cream-coloured lesions Post-equatorally • Vascular sheathing / Disc oedema • Tends to affect One eye few days before the other eye is affected • Prognosis Generally Good • Treatment None effective

  18. 30.11.01 • Review • Noticed improvement • RVA 6/5 LVA 6/4 • Diag: CSCR • review 5/52

  19. 11.1.02 • Sudden loss of VA 2/52 • RVA 6/18 LVA 6/5 • -4.0/-1.5x90 -3.75/-1.25x105 • FFA

  20. 15.1.02 • PIC • MIC • Idiopathic CNVM • Oral pred 40 mg od • f/u 3/52

  21. 5.2.02 • No change in VA • Distortion gone • Developed Diabetes

  22. A.Acute White spots Vanishing later on • MEWDS • Cat-scratch disease • AIDS Microangiopathy • CW spots • Acute Vitelliform maculopathy

  23. B. Acute white spots with coalescence & diffuse scarring • APMPPE • Serpiginous choroiditis • Herpes Retinitis

  24. C. Acute white spots becoming white scars with variable pigmentation • Multifocal choroiditis - classical form • a) PIC • b) Difuse subretinal fibrosis • Toxoplasma retinochoroiditis • Tuberculous chorioretinitis • Syphilitic chorioretinitis • Lyme disease

  25. C. Acute white spots becoming white scars with variable pigmentation • Sarcoidosis • Sympathetic Ophthalmia • VKH • Bacterial retinochoroiditis • Fungal retinochoroiditis • Pneumocystis carinii choroiditis

  26. D. Late white spots with or without initial orange spots • Birdshot choroidopathy

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