2/1/2017

1

VRS Meeting 2017

16 yo girl

Decrease in vision gradually OS over the last year

Va 20/20 OD, 20/70 OS

SLE normal OU

Fundus OD Avascular temporally with dot heme

PMHx- Negative per the patient

Fundus OS

OCT Surgery

Vitrectomy, Membrane Stripping, Laser, AFX OS

Mother: Patient was born at 26 weeks,monitored for ROP, but no treatment required or given

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2

Adult ROP after PPV Va 20/40+

Adult ROP

Patients premature with low birth weights, don’t receive treatment as an infant

Later in life prone to RD, vitreous hemorrhage or tractional ERM

Mean age 22, but majority 8-20 years old

Good success with PPV and or SB if membranes are not severe

61 yo Male

Slight decrease in peripheral vision OD

Told he had retinoschisis

PMHx Sleep Apnea

VA 20/20 OD, 20/20 OS

IOP 15,16

SLE normal OD/OS

Fundus normal OS

Fundus OD FA

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3

OCT OCT of lesion

Diagnosis/Management Choroidal Hemangioma

Average age at diagnosis is >50 Peripapillary or macular location common Serous detachment surrounding the lesion

causes the initial visual symptoms If treatment is required

Laser Photodynamic Therapy

Diffuse form seen in Sturge-Weber syndrome (Nevus flammeus, glaucoma, seizures, etc)

Sometimes called choroidal cavernous hemangioma

67 yo 20/25 vision 17 yo Male

Slight decrease in vision OD, of unclear duration, maybe just since his exam

Told he had a BRVO

Va 20/30 OD, 20/20 OS IOP NL OU SLE NL OU Fundus Normal OS PMH negative

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4

Fundus OD Diagnosis/ Management

Retinal Cavernous Hemangioma

Saccular aneurysms filled with dark venous blood, “cluster of grapes”projecting from the inner retinal surface

Average age at diagnosis 23

Most sporadic, but rare neurocutaneous syndrome with optic nerve, optic tract and brain lesions

Observation unless recurrent VH

52 yo female Sent for a retinal detachment OD, same day surgery

Symptoms for 2 years PMHx Factor II Clotting Disorder, Thyroid Disease,

Asthma, Endometriosis, Hypertension

Va 20/50 OD, 20/20 OS IOP NL OU SLE NL OU Fundus NL OS

Fundus OD

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5

Diagnosis/Management? Coats’ disease Atypical presentation Young males, less than 10% females Peripheral exudation can be severe and

asymptomatic Treatment can cause severe CME Multiple treatment modalities required

Anti-vegf IOS Laser Cryo

Caution with PPV

After IOS (1)/Avastin (5)/laser (2) Va 20/20 after CE OD

64 yo Male

Decrease in central OS vision over three days

No pain, photophobia, flashes or floaters

Rash over his upper body and arthralgias of knees, shoulders and back over the last ten days

Past Medical HX

Cholecystectomy

Fish oil, Multivitamin

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6

Exam

Va 20/20 OD, 3/200 OS

IOP 19 OD, 23 OS

Ant Seg normal OU

Fundus OD

Fundus OS

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7

Questions? 2 weeks later, 20/100

6 weeks later, 20/20

Additional history

Had returned 10 days prior from a two week mission trip in Haiti

UAIM

Working diagnosis

Lab work up (negative) Coxsackie A and B

Lyme

RPR

TB skin test

CBC with diff

CDC testing for Dengue IgG positive, IgM negative

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8

Plaque reduction neutralization Technique Due to time lapse between symptoms and

presentation PCR was not thought to be useful. CDC recommended a PRNT due to possible cross reactivity between flaviviruses Zika virus positive

Dengue and Chikungunya were negative

Counseled to avoid unprotected sex with women of child bearing age for 6 months

Zika Virus Arbovirus in the flavivirus family (dengue,

chickungunya) Uganda 1947

Fever, arthralgias and rash 2007 became more widespread, early

cases associated with Guillain- Barre 2015- start of epidemic in Brazil Transmission by mosquito Aedes aegypti

and sexual intercourse

Congenital findings

Microcephaly

Macular atrophy

Chorioretinal scars

Optic nerve anomalies

16 year old

Healthy male, sudden vision loss OD 20/30 OD, 20/20 OS

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9

History

Blue laser 1 Watt exposure from 10 feet away to right eye prior to vision loss

20 yo blue laser injury, 1 W Laser injury

11 yo OD, 20/60 11 yo OS 20/150

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10

11 yo, Bilateral Red Laser Thank You

2007, 41 yo female 2008

2010 2012

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11

2013 2014

2016, Va 20/100 October 2016

Sudden vision loss in new area

Va 20/20 OD, 20/150 OS

IOP NL OU

SLE NL OU

Fundus OD normal

Fundus OS Mild Vit Cell

November 2016

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12

December 2016, Va 20/80 Outer Retinal Toxoplasmosis

Classic toxoplasmosis Full thickness retinal involvement and

severe vitritis (headlight in the fog)

Deep or outer retinal toxo Deep retinal whitening with little or no vitritis

IgG and IgM positive for toxo Therapy can limit atrophy?