Vitreomacular Traction with Macular Edema
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80-year-old woman had vitrectomy surgery done in the right eye in 2007. Recently her vision in the left eye has been declining. She has had health problems. She had fluid on her lungs and had over a liter of fluid removed. She is recovering from that nicely. The vision has declined in the left eye and you suggested she come here for an evaluation.
VISUAL ACUITY: Vision OD is 20/160, OS is 20/80. IOP: OD 17, OS 14. The posterior chamber intraocular lens is in good position in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.5. There are patches of vitreoretinal traction around the macula.
OS: Vertical C/D ratio is 0.5. There are patches of vitreoretinal traction around the macula.
OCT SCAN: The OCT scan does show minimal retinal thickening in the left eye more than previously. The average thickness in the right eye is 242 microns and the left eye 355 microns.
PHOTOGRAPHS: Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: The FA shows unusual areas of peripheral hyperfluorescence corresponding to areas of eccentric vitreomacular traction and there is cystoid edema with staining in the macula in the left frame, but there is not differential staining of the optic nerve.
IMPRESSION:
1. PROBABLE TRACTIONAL CYSTOID MACULAR EDEMA – LEFT EYE
2. PERIPHERAL RETINAL EDEMA FROM VITREOMACULAR TRACTION – BOTH EYES
3. POOR VISION – RIGHT EYE
4. PREVIOUS VITRECTOMY – RIGHT EYE
DISCUSSION: I explained to the patient the vision in the left eye has declined from 20/40 down to 20/80. It does look like it is probably from vitreomacular traction. Still, there is a risk of surgery. This is her only eye and she is 80 years old. I suggest we start now with anti-inflammatory drops for a month to see if that will help her vision. If it does not, I will try a posterior sub-Tenon Kenalog injection. If that does not help, then I will probably suggest surgery.
I will keep you abreast of her progress. I have contacted the head of the company for microplasmin which would help her, and he said with the FDA process, it will not be available for at least a year or two.
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye583 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye462 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye403 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye425 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye430 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye421 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye368 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye376 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye393 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye414 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye456 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye380 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye449 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye372 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye388 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye371 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye410 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye428 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye403 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye406 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye437 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye439 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye366 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye403 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye415 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye422 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye489 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye454 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye464 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye463 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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Vitreomacular traction with traction over retinal vessels in non-diabetic - Fluorescein leakage in areas of traction - Progressing vision loss left eye562 views80-year-old woman had vitrectomy surgery done in the right eye in 2007. Vision has been poor since despite a good anatomical result. Recently her vision in the left eye has been declining. The vision has declined in the left eye. Vision OD is 20/160, OS is 20/80
(0 votes)
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80-year-old woman had vitrectomy surgery done in the right eye in 2007. Recently her vision in the left eye has been declining. She has had health problems. She had fluid on her lungs and had over a liter of fluid removed. She is recovering from that nicely. The vision has declined in the left eye and you suggested she come here for an evaluation.
VISUAL ACUITY: Vision OD is 20/160, OS is 20/80. IOP: OD 17, OS 14. The posterior chamber intraocular lens is in good position in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.5. There are patches of vitreoretinal traction around the macula.
OS: Vertical C/D ratio is 0.5. There are patches of vitreoretinal traction around the macula.
OCT SCAN: The OCT scan does show minimal retinal thickening in the left eye more than previously. The average thickness in the right eye is 242 microns and the left eye 355 microns.
PHOTOGRAPHS: Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: The FA shows unusual areas of peripheral hyperfluorescence corresponding to areas of eccentric vitreomacular traction and there is cystoid edema with staining in the macula in the left frame, but there is not differential staining of the optic nerve.
IMPRESSION:
1. PROBABLE TRACTIONAL CYSTOID MACULAR EDEMA – LEFT EYE
2. PERIPHERAL RETINAL EDEMA FROM VITREOMACULAR TRACTION – BOTH EYES
3. POOR VISION – RIGHT EYE
4. PREVIOUS VITRECTOMY – RIGHT EYE
DISCUSSION: I explained to the patient the vision in the left eye has declined from 20/40 down to 20/80. It does look like it is probably from vitreomacular traction. Still, there is a risk of surgery. This is her only eye and she is 80 years old. I suggest we start now with anti-inflammatory drops for a month to see if that will help her vision. If it does not, I will try a posterior sub-Tenon Kenalog injection. If that does not help, then I will probably suggest surgery.
I will keep you abreast of her progress. I have contacted the head of the company for microplasmin which would help her, and he said with the FDA process, it will not be available for at least a year or two.
