Maurice F. Rabb » Leaky Parafoveal Capillaries

This 64 year old University of Wisconsin faculty member lost his left eye in a childhood accident. He has been in good health except for mild hypertension, noted in 1977, and controlled well with hydralazine and hydrochlorothiazide.

He came to the Eye Clinic on April 23, 1981 complaining of impaired vision. When reading his glasses seemed dirty and he needed more light. Visual acuity was 20/20 with best correction. The patient had been struck on the head by a tree limb shortly before the onset of visual disturbance. Ocular examination was normal except for a questionable serous fluid in the macula.

The patient was seen in the Retina Clinic May 11, 1981. Visual acuity had improved to 20/15+5. Fluorescein angiography was essentially normal. The patient returned on May 20, 1981, stating that vision had become blurred again the previous day. Visual acuity was 20/20-3. Serous fluid was noted in the macula. There was no evidence of pars plantis. Fluorescein angiography shows dilated parafoveal capillaries with leakage and small cystoid spaces. Prednisone 15 mgm t.i.d. was started.

Six days later visual acuity was 20/15+4, and little or no fluid could be seen in the macula. Fluorescein angiography is normal.

Prednisone was tapered and the patient did well until June 11, 1982, when he presented with one week history of blurred vision. Visual acuity was 20/20+3. He had been using chain saw and splitting wood regularly for several months. Fluid was again noted in the macula. Fluorescein angiography again showed slight dilation of parafoveal capillaries, leakage and small cystoid spaces. Presnisone 40 mgm every other day was started.

One week later no change, visual acuity 20/30, prednisone increased to 45 mgm qid. One week later visual acuity 20/15+. Prednisone tapered. Decreased vision occurred and steroids increased to 30 mgm/day. Vision cleared. Stereoids tapered. Currently asymptomatic on 5 mgm prednisone q.o.d.