Retinal Imaging Conference. Doug Sigford , M.D. University of Louisville Department of Ophthalmology and Visual Sciences 1/9/2014. Patient Presentation. CC : Routine diabetic eye exam
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Doug Sigford, M.D.
University of Louisville
Department of Ophthalmology and Visual Sciences
CC: Routine diabetic eye exam
HPI: 51 y/o white male without complaint presented for a routine diabetic eye exam. He had a 38 year history of type 1 diabetes mellitus, but no history of diabetic eye disease.
POHx: Radial Keratotomy OS
PMH: DM, HIV, hyperlipidemia
CD4 944 cells/μl, viral load undetectable
Meds: Insulin, ezetimibe, atorvastatin, efavirenz,
fosamprenavir, raltegravir , ritonavir
ROS: Unremarkable, no recent illness
OD: Neurosensory detachment of the inferior macula including the fovea with underlying deep yellow lesions and RPE atrophy. Inferior cotton wool spots are also seen.
OS: Deep yellow lesions with areas of RPE atrophy
Large temporal chorioretinal scar
OD: Hyperautofluorescenceis seen in the periphery of the neurosensory detachment and patchy hypoautofluorescence is seen centrally.
OS: Mild perifovealhyperautofluorescence
OCT through the fovea shows subretinal fluid, RPE disruption, and hyperreflective spots in the outer retina
OCT inferior to the fovea shows more subretinal fluid, CME, increased disruption of the RPE, and increased hyperreflective spots in the outer retina.
FA (right) shows early hyperfluorescence primarily in the central portion of the neurosensory detachment. ICG (left) shows both hyper- and hypofluorescence in the same area.
FA (right) shows increased hyperfluorescence consistent with leakage and pooling. ICG (left) shows stable hyper- and hypofluorescence.
FA (right) shows punctate areas of hyperfluorescence corresponding to the subretinal yellow lesions seen clinically. ICG (left) shows small hypofluorescent and hyperfluorescent areas.
Late FA and ICG show stable macular features as well as the large temporal chorioretinal scar
2 week follow-up showed decreased subretinal fluid
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