Maurice F. Rabb » Retinal Vasculitis And Cystoid Macular Edema (CME)

I saw this 51 year old woman back in July of 1998. She was referred in with a history of distored vision for about one year, the left eye being worse than the right eye. She had a history of "arthritis" involving her wrist, fingers, toes, shoulders, etc. She has had some nodules on her fingers, felt to be osteoarthritis for the past 10 years. She had no other constitutional symptoms except for the arthralgias that are chronic. She has been taking Normodyne and Daypro. She was referred in on Acular to both eyes four times a day, and she was placed on this by her general ophthalmologist. With correction, her vision was 20/25 in the right eye and 20/60 in the left eye. Her anterior segment exam was normal without evidence of uveitis. There were no vitreous cells. Her macula had edema as you could tell by her fluorescein angiograms. The only abnormality in her peripheral retinae was a faint whitening along a venule at around 6:00 in both eyes. I assumed this was a mild vascular sheathing, though there was no evidence of snowbanks, inflammatory snowballing or cells in general. Because of a seemingly rheumatologic history and the suspicion of mild retinal vasculitis that might be causing her CME, I ordered a PPD, VDRL, ANA, sed rate, FTA, angiotensin converting enzyme level, CBC, Lyme titer, rheumatoid factor, and a chest x-ray. The results of her testing showed an elevated sedimentation rate which was 91. All the other tests were normal. Presumed diagnosis is retinal vasculitis and CME.