Last additions - Angioid Streaks - Band Keratopathy - Indocyanine Green Angiogram (ICG) 79-year-old man has wet age-related macular degeneration in the left eye, for which he is having Lucentis treatment. His vision since last visit is about stable. He has good vision in the right eye. The left eye is a little bit limited, but he uses that eye more for near than for far.
VISUAL ACUITY: OD 20/40, Pinhole 20/32. OS 20/160, Pinhole 20/50. IOP: OD 14, OS 18. He has band keratopathy sparing the visual axis in both eyes and a posterior chamber intraocular lens in good position in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. There are patchy hyper pigment spots around the fovea with some atrophy nasally. There is no intraretinal or subretinal fluid.
OS: Vertical C/D ratio is 0.2. There is a pigment epithelial detachment in the center of the macula.
SPECTRALIS-SD-OCT SCAN: The OCT scan of the right eye does show some pigment epithelium thickening nasal to the fovea with atrophy superonasal to the fovea. There is no intraretinal or subretinal fluid. The left eye shows a pigment epithelial detachment centrally with atrophy nasal to the fovea. There is no intraretinal or subretinal fluid.
FUNDUS PHOTOGRAPHY - INFRA RED: The image of the right eye shows a patch of atrophy nasal to the fovea. The size of the area of atrophy is roughly 1.2 mm2 and the edge of the atrophy appears to stop about a half millimeter short of the foveal avascular zone. The image of the left eye similarly shows an area of atrophy nasal to the fovea roughly 1.6 mm2 and the pigment epithelial detachment centrally is about 3.5 mm2.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography was obtained with early images in the left eye showing a window defect nasal to the fovea where the atrophy is and centrally there is mostly hypofluorescence in the early frames with some minimal staining of the macula into the late frames, however, the neovascular complex isn’t clearly visible. The fluorescein angiogram in the right eye shows patchy speckled hypofluorescence corresponding to the hyperpigmented spots visible on the funduscopy exam. There is some increasing hyperfluorescence nasal to the fovea where the area of atrophy is.
INDOCYANINE GREEN ANGIOGRAPHY: The left eye shows a clear cut neovascular complex in the late frames centrally measuring 2.7 mm2. There also looked to be angioid streaks on the indocyanine green angiogram. The right eye similarly shows angioid streaks.
IMPRESSION:
1. ANGIOID STREAKS – BOTH EYES
2. AGE-RELATED MACULAR DEGENERATION – LEFT EYE
3. PIGMENT EPITHELIAL DETACHMENT – LEFT EYE
4. BAND KERATOPATHY – BOTH EYES
DISCUSSION: I explained to the patient with intravitreal Lucentis there is a reasonable chance of maintaining the vision in the left eye. The office visit included a 15-minute counseling session during which I reviewed the alternatives, risks, benefits and limitations of various treatment options. I treated the left eye with intravitreal injection of Lucentis (0.5 mg/0.05 ml) without any difficulty today. In addition the images of the streaks are a new finding in him with that and the band keratopathy in the cornea. I am going to spend some time looking around to see if maybe he has a syndrome that we hadn’t previously recognized.
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Angioid Streaks and Macular Degeneration - CNVM OS - Band Keratopathy 779 views79-year-old man has wet age-related macular degeneration in the left eye, for which he is having Lucentis treatment. OD 20/40, Pinhole 20/32. OS 20/160, Pinhole 20/50. He has band keratopathy sparing the visual axis in both eyes. ICG shows angioid streaks both eye.Oct 16, 2012
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Angioid Streaks and Macular Degeneration - CNVM OS - Band Keratopathy 705 views79-year-old man has wet age-related macular degeneration in the left eye, for which he is having Lucentis treatment. OD 20/40, Pinhole 20/32. OS 20/160, Pinhole 20/50. He has band keratopathy sparing the visual axis in both eyes. ICG shows angioid streaks both eye.Oct 16, 2012
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Angioid Streaks and Macular Degeneration - CNVM OS - Band Keratopathy 683 views79-year-old man has wet age-related macular degeneration in the left eye, for which he is having Lucentis treatment. OD 20/40, Pinhole 20/32. OS 20/160, Pinhole 20/50. He has band keratopathy sparing the visual axis in both eyes. ICG shows angioid streaks both eye.Oct 16, 2012
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Angioid Streaks and Macular Degeneration - CNVM OS - Band Keratopathy 594 views79-year-old man has wet age-related macular degeneration in the left eye, for which he is having Lucentis treatment. OD 20/40, Pinhole 20/32. OS 20/160, Pinhole 20/50. He has band keratopathy sparing the visual axis in both eyes. ICG shows angioid streaks both eye.Oct 16, 2012
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Angioid Streaks and Macular Degeneration - CNVM OS - Band Keratopathy 599 views79-year-old man has wet age-related macular degeneration in the left eye, for which he is having Lucentis treatment. OD 20/40, Pinhole 20/32. OS 20/160, Pinhole 20/50. He has band keratopathy sparing the visual axis in both eyes. ICG shows angioid streaks both eye.Oct 16, 2012
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Angioid Streaks and Macular Degeneration - CNVM OS - Band Keratopathy 501 views79-year-old man has wet age-related macular degeneration in the left eye, for which he is having Lucentis treatment. OD 20/40, Pinhole 20/32. OS 20/160, Pinhole 20/50. He has band keratopathy sparing the visual axis in both eyes. ICG shows angioid streaks both eye.Oct 16, 2012
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Angioid Streaks and Macular Degeneration - CNVM OS - Band Keratopathy 451 views79-year-old man has wet age-related macular degeneration in the left eye, for which he is having Lucentis treatment. OD 20/40, Pinhole 20/32. OS 20/160, Pinhole 20/50. He has band keratopathy sparing the visual axis in both eyes. ICG shows angioid streaks both eye.Oct 16, 2012
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Angioid Streaks and Macular Degeneration - CNVM OS - Band Keratopathy 466 views79-year-old man has wet age-related macular degeneration in the left eye, for which he is having Lucentis treatment. OD 20/40, Pinhole 20/32. OS 20/160, Pinhole 20/50. He has band keratopathy sparing the visual axis in both eyes. ICG shows angioid streaks both eye.Oct 16, 2012
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Angioid Streaks and Macular Degeneration - CNVM OS - Band Keratopathy 491 views79-year-old man has wet age-related macular degeneration in the left eye, for which he is having Lucentis treatment. OD 20/40, Pinhole 20/32. OS 20/160, Pinhole 20/50. He has band keratopathy sparing the visual axis in both eyes. ICG shows angioid streaks both eye.Oct 16, 2012
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Angioid Streaks and Macular Degeneration - CNVM OS - Band Keratopathy 525 views79-year-old man has wet age-related macular degeneration in the left eye, for which he is having Lucentis treatment. OD 20/40, Pinhole 20/32. OS 20/160, Pinhole 20/50. He has band keratopathy sparing the visual axis in both eyes. ICG shows angioid streaks both eye.Oct 16, 2012
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Angioid Streaks and Macular Degeneration - CNVM OS - Band Keratopathy 556 views79-year-old man has wet age-related macular degeneration in the left eye, for which he is having Lucentis treatment. OD 20/40, Pinhole 20/32. OS 20/160, Pinhole 20/50. He has band keratopathy sparing the visual axis in both eyes. ICG shows angioid streaks both eye.Oct 16, 2012
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Angioid Streaks and Macular Degeneration - CNVM OS - Band Keratopathy 561 views79-year-old man has wet age-related macular degeneration in the left eye, for which he is having Lucentis treatment. OD 20/40, Pinhole 20/32. OS 20/160, Pinhole 20/50. He has band keratopathy sparing the visual axis in both eyes. ICG shows angioid streaks both eye.Oct 16, 2012
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Angioid Streaks and Macular Degeneration - CNVM OS - Band Keratopathy 539 views79-year-old man has wet age-related macular degeneration in the left eye, for which he is having Lucentis treatment. OD 20/40, Pinhole 20/32. OS 20/160, Pinhole 20/50. He has band keratopathy sparing the visual axis in both eyes. ICG shows angioid streaks both eye.Oct 16, 2012
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Angioid Streaks and Macular Degeneration - CNVM OS - Band Keratopathy 558 views79-year-old man has wet age-related macular degeneration in the left eye, for which he is having Lucentis treatment. OD 20/40, Pinhole 20/32. OS 20/160, Pinhole 20/50. He has band keratopathy sparing the visual axis in both eyes. ICG shows angioid streaks both eye.Oct 16, 2012
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Angioid Streaks and Macular Degeneration - CNVM OS - Band Keratopathy 621 views79-year-old man has wet age-related macular degeneration in the left eye, for which he is having Lucentis treatment. OD 20/40, Pinhole 20/32. OS 20/160, Pinhole 20/50. He has band keratopathy sparing the visual axis in both eyes. ICG shows angioid streaks both eye.Oct 16, 2012
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Angioid Streaks and Macular Degeneration - CNVM OS - Band Keratopathy 615 views79-year-old man has wet age-related macular degeneration in the left eye, for which he is having Lucentis treatment. OD 20/40, Pinhole 20/32. OS 20/160, Pinhole 20/50. He has band keratopathy sparing the visual axis in both eyes. ICG shows angioid streaks both eye.Oct 16, 2012
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Angioid Streaks and Macular Degeneration - CNVM OS - Band Keratopathy 566 views79-year-old man has wet age-related macular degeneration in the left eye, for which he is having Lucentis treatment. OD 20/40, Pinhole 20/32. OS 20/160, Pinhole 20/50. He has band keratopathy sparing the visual axis in both eyes. ICG shows angioid streaks both eye.Oct 16, 2012
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Angioid Streaks and Macular Degeneration - CNVM OS - Band Keratopathy 735 views79-year-old man has wet age-related macular degeneration in the left eye, for which he is having Lucentis treatment. OD 20/40, Pinhole 20/32. OS 20/160, Pinhole 20/50. He has band keratopathy sparing the visual axis in both eyes. ICG shows angioid streaks both eye.Oct 16, 2012
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79-year-old man has wet age-related macular degeneration in the left eye, for which he is having Lucentis treatment. His vision since last visit is about stable. He has good vision in the right eye. The left eye is a little bit limited, but he uses that eye more for near than for far.
VISUAL ACUITY: OD 20/40, Pinhole 20/32. OS 20/160, Pinhole 20/50. IOP: OD 14, OS 18. He has band keratopathy sparing the visual axis in both eyes and a posterior chamber intraocular lens in good position in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. There are patchy hyper pigment spots around the fovea with some atrophy nasally. There is no intraretinal or subretinal fluid.
OS: Vertical C/D ratio is 0.2. There is a pigment epithelial detachment in the center of the macula.
SPECTRALIS-SD-OCT SCAN: The OCT scan of the right eye does show some pigment epithelium thickening nasal to the fovea with atrophy superonasal to the fovea. There is no intraretinal or subretinal fluid. The left eye shows a pigment epithelial detachment centrally with atrophy nasal to the fovea. There is no intraretinal or subretinal fluid.
FUNDUS PHOTOGRAPHY - INFRA RED: The image of the right eye shows a patch of atrophy nasal to the fovea. The size of the area of atrophy is roughly 1.2 mm2 and the edge of the atrophy appears to stop about a half millimeter short of the foveal avascular zone. The image of the left eye similarly shows an area of atrophy nasal to the fovea roughly 1.6 mm2 and the pigment epithelial detachment centrally is about 3.5 mm2.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography was obtained with early images in the left eye showing a window defect nasal to the fovea where the atrophy is and centrally there is mostly hypofluorescence in the early frames with some minimal staining of the macula into the late frames, however, the neovascular complex isn’t clearly visible. The fluorescein angiogram in the right eye shows patchy speckled hypofluorescence corresponding to the hyperpigmented spots visible on the funduscopy exam. There is some increasing hyperfluorescence nasal to the fovea where the area of atrophy is.
INDOCYANINE GREEN ANGIOGRAPHY: The left eye shows a clear cut neovascular complex in the late frames centrally measuring 2.7 mm2. There also looked to be angioid streaks on the indocyanine green angiogram. The right eye similarly shows angioid streaks.
IMPRESSION:
1. ANGIOID STREAKS – BOTH EYES
2. AGE-RELATED MACULAR DEGENERATION – LEFT EYE
3. PIGMENT EPITHELIAL DETACHMENT – LEFT EYE
4. BAND KERATOPATHY – BOTH EYES
DISCUSSION: I explained to the patient with intravitreal Lucentis there is a reasonable chance of maintaining the vision in the left eye. The office visit included a 15-minute counseling session during which I reviewed the alternatives, risks, benefits and limitations of various treatment options. I treated the left eye with intravitreal injection of Lucentis (0.5 mg/0.05 ml) without any difficulty today. In addition the images of the streaks are a new finding in him with that and the band keratopathy in the cornea. I am going to spend some time looking around to see if maybe he has a syndrome that we hadn’t previously recognized.
