65 year old with 20/200 vision

Posted by - Posted on 10/30/2016 23:54:36 Retina and Uveitis


65 year old african american patient post un complicated cataract surgery presents with decreased vision. OCT findings attached. 

1. What is the treatment of choice if the FA sugegsts lack of late stage leakage and had family history of poor vision 

2. If this patient has underlying Diabetes along with the OCT macular findings, which of the following has better long term prognosis - focal laser vs Intravitreal triamcinolone  injection.

3. In example 2, what is the diagnostic test of choice - FA vs OCT? 

4. If this OCT apperance is secondary to CRVO, what is the chance of this patients's vision improving with 1 mg of triamcinolone injection vs ranibizumab?

Leave a Comment:

Alex Yelenskiy 11/07/2016 02:35:24

No late leakage with FHx of poor vision can be RP or x-linked retinoschisis. Likely RP, so Vitamin A is reasonable, as well as diamox. Even though the CME is next to fovea, would this be amenable to Micropulse laser? If not, then IV injection. FA would be diagnostic to confirm active areas of leakage. Lastly, ranibizumab is preferred in CRVO.

Joshua Frenkel 11/07/2016 01:39:07

1. No late leakage on FA FHx of poor vision suggests RP. As such, vitamin A supplementation along with acetazolamide for the CME would be recommended.2. In a diabetic, focal laser has the better long term prognosis but I would not recommend lasering near the fovea, so injections would be preferred in this case.3. IVFA would be the test of choice to pinpoint areas of leakage for diagnosis and treatment 4. Ranibizumab would be preferred

Ze Zhang 11/06/2016 21:49:54

1. CME without leakage with FH of poor vision suggests RP, treatment would start with vitamin A supplementation2. Assuming the leaking microaneurysm can be identified on IVFA, focal laser is preferred over injections. However, this OCT shows central foveal CSME, which is not amenable to laser, thus, intravitreal injections may be necessary. 3. While OCT shows the areas of edema, IVFA is the diagnostic test to confirm leakage. 4. Ranibizumab is preferred over steroids for ME from CRVO.

Crystal Le 11/04/2016 12:29:51

1. Acetazolamide 2. Focal laser 3. FA in order to target diseased vessels 4. Ranibizumab

Drew Salisbury 11/01/2016 23:34:03

1. DIamox 2. Focal laser has better long term prognosis however I would not laser near the fovea 3. FA to determine areas of leakage amenable to focal laser 4. Chances of visual improvement are greater with ranibizumab injection compared to triamcinolone in CRVO