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.