90-year-old man who I saw in the office on September 10, 2009. He recently moved to Florida from New York because his wife passed away. He had cataract surgery a little over a year ago and since the time of the cataract surgery he notices his vision in both eyes of his eyes is poor to the point where he is no longer able to read. His old chart does document that he has had branch retinal vein occlusions in both eyes in the past. It is a little difficult to sort out how long his vision has been poor. It is possible his vision in the right eye has been poor for as much as ten years. Some of the vision loss they feel previous to the cataract surgery might have been from the cataract, but it sounds like some of it might have been also from the retinal vascular occlusions.
VISUAL ACUITY: OD 20/200, OS 20/200. IOP: OD 11, OS 10.
SLIT EXAMINATION: The posterior chamber intraocular lens is in good position in both eyes. The left eye has a 2+ posterior capsular opacity.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. There is an inferotemporal macular branch retinal vein occlusion. There is a well-defined, almost perfectly circular ring of pigment epithelial atrophy centrally, which is something you would see in someone who has had chronic severe cystoid macular edema for a long time.
OS: Vertical C/D ratio is 0.2. There is a pigment spot under the fovea, which is hyperpigmented possibly from macular degeneration, but also from chronic macular edema. There is a superotemporal branch retinal vein occlusion affecting an area just inside the arcades. There are a few patchy retinal hemorrhages in the periphery.
OCT SCAN: The OCT scan shows in the right eye retinal atrophy. The left eye shows macular edema. Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography confirms a branch retinal vein occlusion in both eyes with severe capillary non profusion of the inferior half of the macula in the right eye and the superior half of the macula in the left eye. There is late leakage into the fovea in the left eye.
IMPRESSION:
1. CYSTOID MACULAR EDEMA – LEFT EYE
2. MACULAR BRANCH RETINAL VEIN OCCLUSION – LEFT EYE
3. DIABETIC RETINOPATHY – LEFT EYE
4. MACULAR SCAR – RIGHT EYE
5. BRANCH RETINAL VEIN OCCLUSION – RIGHT EYE
DISCUSSION: I explained to the patient unfortunately the macula has scarring and atrophy and permanent vision loss. The left eye with the macular edema though may be responsive to treatment. I suggest that we try intravitreal Kenalog today, which I injected .05 cc. I asked him to return for a check in one month, depending on how he does it may be worthwhile considering it in the future, focal laser to that area of leakage.
|
New BRVO Left Eye Old BRVO Right Eye - Right Eye Showing Bulls Eye Atrophy from Chronic CME and Non-Perfusion Infero-temporally575 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/200
(0 votes)
|
|
New BRVO Left Eye Old BRVO Right Eye - Right Eye Showing Bulls Eye Atrophy from Chronic CME and Non-Perfusion Infero-temporally677 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/200
(0 votes)
|
|
New BRVO Left Eye Old BRVO Right Eye - Right Eye Showing Bulls Eye Atrophy from Chronic CME and Non-Perfusion Infero-temporally660 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/200
(0 votes)
|
|
New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema632 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/200
(0 votes)
|
|
New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema662 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/200
(0 votes)
|
|
New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema486 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/200
(0 votes)
|
|
New BRVO Left Eye Old BRVO Right Eye - Right Eye Showing Bulls Eye Atrophy from Chronic CME and Non-Perfusion Infero-temporally505 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/200
(0 votes)
|
|
New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema479 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/200
(0 votes)
|
|
New BRVO Left Eye Old BRVO Right Eye - Right Eye Showing Bulls Eye Atrophy from Chronic CME and Non-Perfusion Infero-temporally490 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/200
(0 votes)
|
|
New BRVO Left Eye Old BRVO Right Eye - Right Eye Showing Bulls Eye Atrophy from Chronic CME and Non-Perfusion Infero-temporally475 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/200
(0 votes)
|
|
New BRVO Left Eye Old BRVO Right Eye - Right Eye Showing Bulls Eye Atrophy from Chronic CME and Non-Perfusion Infero-temporally465 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/200
(0 votes)
|
|
New BRVO Left Eye Old BRVO Right Eye 407 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/200
(0 votes)
|
|
New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema470 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/200
(0 votes)
|
|
New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema571 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/200
(0 votes)
|
|
New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema528 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/200
(0 votes)
|
|
New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema409 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/200
(0 votes)
|
|
New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema Arrow Shows Site of Occlusion527 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/200
(0 votes)
|
|
New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema436 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/200
(0 votes)
|
|
New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema425 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/200
(0 votes)
|
|
New BRVO Left Eye Old BRVO Right Eye - Right Eye Showing Bulls Eye Atrophy from Chronic CME and Non-Perfusion Infero-temporally551 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/200
(0 votes)
|
|
New BRVO Left Eye Old BRVO Right Eye - Right Eye Showing Bulls Eye Atrophy from Chronic CME and Non-Perfusion Infero-temporally459 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/200
(0 votes)
|
|
New BRVO Left Eye Old BRVO Right Eye - Right Eye Showing Bulls Eye Atrophy from Chronic CME and Non-Perfusion Infero-temporally523 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/200
(0 votes)
|
|
New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema525 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/200
(0 votes)
|
|
New BRVO Left Eye Old BRVO Right Eye - Left Eye Shows Twig Superior Vein Occlusion with Edema477 views90-year-old man decreased vision maybe one year since cataract surgery he is no longer able to read. OD 20/200, OS 20/200
(0 votes)
|
|
|
|
90-year-old man who I saw in the office on September 10, 2009. He recently moved to Florida from New York because his wife passed away. He had cataract surgery a little over a year ago and since the time of the cataract surgery he notices his vision in both eyes of his eyes is poor to the point where he is no longer able to read. His old chart does document that he has had branch retinal vein occlusions in both eyes in the past. It is a little difficult to sort out how long his vision has been poor. It is possible his vision in the right eye has been poor for as much as ten years. Some of the vision loss they feel previous to the cataract surgery might have been from the cataract, but it sounds like some of it might have been also from the retinal vascular occlusions.
VISUAL ACUITY: OD 20/200, OS 20/200. IOP: OD 11, OS 10.
SLIT EXAMINATION: The posterior chamber intraocular lens is in good position in both eyes. The left eye has a 2+ posterior capsular opacity.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. There is an inferotemporal macular branch retinal vein occlusion. There is a well-defined, almost perfectly circular ring of pigment epithelial atrophy centrally, which is something you would see in someone who has had chronic severe cystoid macular edema for a long time.
OS: Vertical C/D ratio is 0.2. There is a pigment spot under the fovea, which is hyperpigmented possibly from macular degeneration, but also from chronic macular edema. There is a superotemporal branch retinal vein occlusion affecting an area just inside the arcades. There are a few patchy retinal hemorrhages in the periphery.
OCT SCAN: The OCT scan shows in the right eye retinal atrophy. The left eye shows macular edema. Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography confirms a branch retinal vein occlusion in both eyes with severe capillary non profusion of the inferior half of the macula in the right eye and the superior half of the macula in the left eye. There is late leakage into the fovea in the left eye.
IMPRESSION:
1. CYSTOID MACULAR EDEMA – LEFT EYE
2. MACULAR BRANCH RETINAL VEIN OCCLUSION – LEFT EYE
3. DIABETIC RETINOPATHY – LEFT EYE
4. MACULAR SCAR – RIGHT EYE
5. BRANCH RETINAL VEIN OCCLUSION – RIGHT EYE
DISCUSSION: I explained to the patient unfortunately the macula has scarring and atrophy and permanent vision loss. The left eye with the macular edema though may be responsive to treatment. I suggest that we try intravitreal Kenalog today, which I injected .05 cc. I asked him to return for a check in one month, depending on how he does it may be worthwhile considering it in the future, focal laser to that area of leakage.
