Hlstory/Chief Complaint

  • 33 year old myopic white female presents with vague complaints of blurred vision in the left eye.

Clinical Finding

  • BCVA: 20/20 OD and 20/20 OS
  • Refractive Error:
    OD -9.00
    OS -9.00

Fundus Exam:

  • OD: Mild diffuse myopic thinning unmasking the underlying large choroidal vessels.
  • OS: Small scattered zones of chorioretinal atrophy unmasking the underlying sclera around the optic disc and in the nasal fundus and an apparent small, subtle grey zone below the fovea.
  • optomap®: Documents the above fundus findings.

Preferential Hyperacuity Perimeter (PHP)

  • Normal OD and abnormal OS.
  • OS: Two hyperacuity defect zones linked together in the superior visual field with a high cluster consistency.

Zeiss Stratus and Cirrus OCT

  • Retinal thickening and elevation below the fovea OS as well as a corresponding disruption at the level of the RPE and photoreceptor integrity line, PIL (see page 19) OS.

Fluorescein angiogram (FA)

  • Reveals a zone of leakage below the fovea OS that increases and expands over a several minute period.

Diagnosis

  • CNV inferior to the fovea OS secondary to high myopia
  • Recommendation: begin intravitreal injections of antl-VEGF agents -either Lucentis or Avastin

Follow up

  • Several treatments were successful in retaining VA at 20/20 OS for nearly a year but regrettably VA then declined somewhat due to recurrent CNV and hemorrhage OS
  • The introductory panoramic image is the most recently available image and demonstrates a CNV membrane with a small scar and a small isolated hemorrhage in the macula OS
  • Combination treatment has been initiated.