1 / 28

Case Presentation

Case Presentation. 1.3.2002 SINGLETON HOSPITAL. History. GP referral RE visual loss R 9/6 L6/6 ?RP 16.11.01 54yr old myopic Caucasian male 2/7 distorted vision POH Myope since childhood PMH unremarkable. 16.11.01. No medical Treatment Penicillin Allergy FH Mother had cataract.

charity
Download Presentation

Case Presentation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Case Presentation 1.3.2002 SINGLETON HOSPITAL

  2. History GP referral RE visual loss R 9/6 L6/6 ?RP 16.11.01 • 54yr old myopic Caucasian male • 2/7 distorted vision • POH Myope since childhood • PMH unremarkable

  3. 16.11.01 • No medical Treatment • Penicillin Allergy • FH Mother had cataract

  4. 16.11.01 • VA R 6/6 L 6/5 • Near R N/10 L N/5 (distorted) • Normal Anterior Segment • Posterior segment • lytic lesions, distributed in peripapillary • foveal fluid & marginal hg

  5. 16.11.01 • DD • Old /new CSCR • central CNVM 2 to ?POHS • FFA on 28.11.01

  6. Differential Diagnosis • Myopic degeneration • MIC (multifocal inner choroidopathy) • PIC (punctate inner choroidopathy) • POHS (Presumed ocular histoplasmosis syndrome) • Idiopathic CNVM

  7. Differential Diagnosis • Birdshot Chorioretinopathy • APMPPE (acute posterior multiple placoid pigment epitheliopathy)

  8. MIC • Age: 20 - 50 yrs • F:M 3:1 • Young healthy moderately myope • C/O • Subacute blurred vision • Floaters

  9. MIC Examination • 50% - AAU • Vitritis + multiple grey -white/ yellow lesions at RPE/ inner choroid • New lesions & recurrences occur Prognosis Fair • Visual loss: CMO/CNVM Treatment • Periocular steroid

  10. PIC • Young healthy myope • Commoner in female • Unknown etiology • C/O • acute decreased VA/ central Scotoma

  11. PIC • Exam • Quiet Anterior segment • Multiple white/yellow lesion in peripapillary region/ fovea in RPE/IC level +/- serous elevation of NSR • No vitritis • 1/3 rd develop CNVM • Prognosis Good • Treatment Controversial • Steroid • Submacular surgery

  12. POHS • Endemic area of Ohio-Missisipi river valley • Exam • Histo spots • atrophic punched out lesions around the disc • maculopathy : pigment ring with overlying NSR det. • Maculopathy develops in 2nd decade • NO vitritis

  13. POHS • Treatment • early stages: steroids • CNVM: Photocoagulation/ Submacular sx • Prognosis Variable • Without treatment 59% with VA worse than 6/60 • Histo spots in macular area 25% chance of attack over next 3yrs • No spots in macular area 2% chance of attack

  14. Birdshot chorioretinopathy • Uncommon • F>M past 4th decade • HLA- A29 (50-80%) • C/O • Reduced VA, nyctalopia • Colour VA disturbed

  15. Birdshot chorioretinopathy • Exam • Minimal/No Anterior segment inflamm • Cream coloured depigmented spots throughout fundus (birdshot from a shotgun) • attenuated & sheathed vessel, disc oedema, OA • CMO • Reduced ERG • Treatment • Periocular / systemic steroids

  16. APMPPE • Young adults • F:M 1:1 • Assoc. HLA DR2 & HLA B7 • C/O • Unilateral visual loss • prodromal flu-like symptomps 50% • few has CNS vasculitis

  17. APMPPE • Exam • Deep placoid cream-coloured lesions Post-equatorally • Vascular sheathing / Disc oedema • Tends to affect One eye few days before the other eye is affected • Prognosis Generally Good • Treatment None effective

  18. 30.11.01 • Review • Noticed improvement • RVA 6/5 LVA 6/4 • Diag: CSCR • review 5/52

  19. 11.1.02 • Sudden loss of VA 2/52 • RVA 6/18 LVA 6/5 • -4.0/-1.5x90 -3.75/-1.25x105 • FFA

  20. 15.1.02 • PIC • MIC • Idiopathic CNVM • Oral pred 40 mg od • f/u 3/52

  21. 5.2.02 • No change in VA • Distortion gone • Developed Diabetes

  22. A.Acute White spots Vanishing later on • MEWDS • Cat-scratch disease • AIDS Microangiopathy • CW spots • Acute Vitelliform maculopathy

  23. B. Acute white spots with coalescence & diffuse scarring • APMPPE • Serpiginous choroiditis • Herpes Retinitis

  24. C. Acute white spots becoming white scars with variable pigmentation • Multifocal choroiditis - classical form • a) PIC • b) Difuse subretinal fibrosis • Toxoplasma retinochoroiditis • Tuberculous chorioretinitis • Syphilitic chorioretinitis • Lyme disease

  25. C. Acute white spots becoming white scars with variable pigmentation • Sarcoidosis • Sympathetic Ophthalmia • VKH • Bacterial retinochoroiditis • Fungal retinochoroiditis • Pneumocystis carinii choroiditis

  26. D. Late white spots with or without initial orange spots • Birdshot choroidopathy

More Related