Last additions - Sickle Retinopathy - Hemoglobin SC - Proliferative Retinopathy 53-year-old woman was seen in the office on 10/9/2009. She has noticed a new spider-like floater in the right eye for about six days. She sees one big floater and another little one. She seems to be adjusting to it.
She does have hemoglobin SC hemoglobinopathy. She has done fine with surgeries in the past.
VISUAL ACUITY: Vision OD is 20/20; OS is 20/50, PH is 20/20. IOP: OD 17.
AMSLER GRID: Normal in both eyes.
SLIT LAMP EXAM: There is 2+ nuclear sclerosis in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.5. There is a posterior vitreous separation. There is 1+ vitreous hemorrhage. There is a tuft of neovascularization in the periphery at the equator at 8:00 o’clock. There are punched-out chorioretinal scars in the periphery. There is a subclinical retinal detachment surrounding the area of neovascularization where there is vitreoretinal traction.
OS: Vertical C/D ratio is 0.5. There are punched-out hyperpigmented scars in the periphery.
PHOTOGRAPHS: Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: FA shows hyperfluorescence in the areas of the chorioretinal scars. The neovascular complex has a minimal amount of leakage in the late frames in the right eye and there is fairly good perfusion in the periphery of both retinas out to the far periphery as far as the photographic field can show.
IMPRESSION:
1. SICKLE CELL RETINOPATHY – RIGHT EYE MORE THAN LEFT EYE
2. PERIPHERAL PROLIFERATIVE RETINOPATHY – RIGHT EYE
3. VITREORETINAL TRACTION – RIGHT EYE
4. ACUTE VITREOUS SEPARATION WITH VITREOUS HEMORRHAGE – RIGHT EYE
5. RETINAL DETACHMENT – RIGHT EYE
DISCUSSION: I explained to the patient she does have a retinal detachment in the right eye associated with a tuft of neovascularization which is under traction now because of her vitreous separation. I treated that area with laser to barrier-off the retinal detachment. I am concerned about possible problems in the eye in the future though. As the vitreous separation progresses, it may snag the retina in other areas and cause other tears.
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Proliferative Sickle Retinopathy - Hemoglobin SC677 views53-year-old woman with a new spider-like floater in the right eye for about six days. She sees one big floater and another little one. She does have hemoglobin SC hemoglobinopathy. VISUAL ACUITY: Vision OD is 20/20; OS is 20/50, PH is 20/20. Jun 17, 2011
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Proliferative Sickle Retinopathy - Hemoglobin SC487 views53-year-old woman with a new spider-like floater in the right eye for about six days. She sees one big floater and another little one. She does have hemoglobin SC hemoglobinopathy. VISUAL ACUITY: Vision OD is 20/20; OS is 20/50, PH is 20/20. Jun 17, 2011
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Proliferative Sickle Retinopathy - Hemoglobin SC506 views53-year-old woman with a new spider-like floater in the right eye for about six days. She sees one big floater and another little one. She does have hemoglobin SC hemoglobinopathy. VISUAL ACUITY: Vision OD is 20/20; OS is 20/50, PH is 20/20. Jun 17, 2011
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Proliferative Sickle Retinopathy - Hemoglobin SC515 views53-year-old woman with a new spider-like floater in the right eye for about six days. She sees one big floater and another little one. She does have hemoglobin SC hemoglobinopathy. VISUAL ACUITY: Vision OD is 20/20; OS is 20/50, PH is 20/20. Jun 17, 2011
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Proliferative Sickle Retinopathy - Hemoglobin SC536 views53-year-old woman with a new spider-like floater in the right eye for about six days. She sees one big floater and another little one. She does have hemoglobin SC hemoglobinopathy. VISUAL ACUITY: Vision OD is 20/20; OS is 20/50, PH is 20/20. Jun 17, 2011
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Proliferative Sickle Retinopathy - Hemoglobin SC531 views53-year-old woman with a new spider-like floater in the right eye for about six days. She sees one big floater and another little one. She does have hemoglobin SC hemoglobinopathy. VISUAL ACUITY: Vision OD is 20/20; OS is 20/50, PH is 20/20. Jun 17, 2011
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Proliferative Sickle Retinopathy - Hemoglobin SC499 views53-year-old woman with a new spider-like floater in the right eye for about six days. She sees one big floater and another little one. She does have hemoglobin SC hemoglobinopathy. VISUAL ACUITY: Vision OD is 20/20; OS is 20/50, PH is 20/20. Jun 17, 2011
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Proliferative Sickle Retinopathy - Hemoglobin SC606 views53-year-old woman with a new spider-like floater in the right eye for about six days. She sees one big floater and another little one. She does have hemoglobin SC hemoglobinopathy. VISUAL ACUITY: Vision OD is 20/20; OS is 20/50, PH is 20/20. Jun 17, 2011
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Proliferative Sickle Retinopathy - Hemoglobin SC570 views53-year-old woman with a new spider-like floater in the right eye for about six days. She sees one big floater and another little one. She does have hemoglobin SC hemoglobinopathy. VISUAL ACUITY: Vision OD is 20/20; OS is 20/50, PH is 20/20. Jun 17, 2011
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Proliferative Sickle Retinopathy - Hemoglobin SC863 views53-year-old woman with a new spider-like floater in the right eye for about six days. She sees one big floater and another little one. She does have hemoglobin SC hemoglobinopathy. VISUAL ACUITY: Vision OD is 20/20; OS is 20/50, PH is 20/20. Jun 17, 2011
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Proliferative Sickle Retinopathy - Hemoglobin SC580 views53-year-old woman with a new spider-like floater in the right eye for about six days. She sees one big floater and another little one. She does have hemoglobin SC hemoglobinopathy. VISUAL ACUITY: Vision OD is 20/20; OS is 20/50, PH is 20/20. Jun 17, 2011
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Proliferative Sickle Retinopathy - Hemoglobin SC577 views53-year-old woman with a new spider-like floater in the right eye for about six days. She sees one big floater and another little one. She does have hemoglobin SC hemoglobinopathy. VISUAL ACUITY: Vision OD is 20/20; OS is 20/50, PH is 20/20. Jun 17, 2011
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Proliferative Sickle Retinopathy - Hemoglobin SC679 views53-year-old woman with a new spider-like floater in the right eye for about six days. She sees one big floater and another little one. She does have hemoglobin SC hemoglobinopathy. VISUAL ACUITY: Vision OD is 20/20; OS is 20/50, PH is 20/20. Jun 17, 2011
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Proliferative Sickle Retinopathy - Hemoglobin SC800 views53-year-old woman with a new spider-like floater in the right eye for about six days. She sees one big floater and another little one. She does have hemoglobin SC hemoglobinopathy. VISUAL ACUITY: Vision OD is 20/20; OS is 20/50, PH is 20/20. Jun 17, 2011
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53-year-old woman was seen in the office on 10/9/2009. She has noticed a new spider-like floater in the right eye for about six days. She sees one big floater and another little one. She seems to be adjusting to it.
She does have hemoglobin SC hemoglobinopathy. She has done fine with surgeries in the past.
VISUAL ACUITY: Vision OD is 20/20; OS is 20/50, PH is 20/20. IOP: OD 17.
AMSLER GRID: Normal in both eyes.
SLIT LAMP EXAM: There is 2+ nuclear sclerosis in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.5. There is a posterior vitreous separation. There is 1+ vitreous hemorrhage. There is a tuft of neovascularization in the periphery at the equator at 8:00 o’clock. There are punched-out chorioretinal scars in the periphery. There is a subclinical retinal detachment surrounding the area of neovascularization where there is vitreoretinal traction.
OS: Vertical C/D ratio is 0.5. There are punched-out hyperpigmented scars in the periphery.
PHOTOGRAPHS: Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: FA shows hyperfluorescence in the areas of the chorioretinal scars. The neovascular complex has a minimal amount of leakage in the late frames in the right eye and there is fairly good perfusion in the periphery of both retinas out to the far periphery as far as the photographic field can show.
IMPRESSION:
1. SICKLE CELL RETINOPATHY – RIGHT EYE MORE THAN LEFT EYE
2. PERIPHERAL PROLIFERATIVE RETINOPATHY – RIGHT EYE
3. VITREORETINAL TRACTION – RIGHT EYE
4. ACUTE VITREOUS SEPARATION WITH VITREOUS HEMORRHAGE – RIGHT EYE
5. RETINAL DETACHMENT – RIGHT EYE
DISCUSSION: I explained to the patient she does have a retinal detachment in the right eye associated with a tuft of neovascularization which is under traction now because of her vitreous separation. I treated that area with laser to barrier-off the retinal detachment. I am concerned about possible problems in the eye in the future though. As the vitreous separation progresses, it may snag the retina in other areas and cause other tears.
