Niloofar Piri, MD » Miscellaneous

Mar 13 2015 by Niloofar Piri, MD

Fundus photograph of the left eye of a 40-year-old Caucasian female with history of positive HIV test for 23 years. She has been off HAART therapy for the past 2 years and presented with decreased vision OS and upper visual field defect. On examination, she had trace cells in anterior vitreous , hemorrhagic retinitis which starts around the optic nerve and extending to inferotemporal arcade with secondary inferotemporal BRVO; in temporal periphery , she had granular pattern of CMV retinitis which is a manifestation of outer retina involvement.

Photographer: Angela Anderson

Condition/keywords: CMV retinitis, HIV

Mar 13 2015 by Niloofar Piri, MD

The same patient one month after systemic treatment with Gancyclovvir and HAART ; resolved retinitis and hemorrhages, granular pattern remains as the outer retina is damaged.

Photographer: Angela Anderson

Condition/keywords: CMV retinitis, HIV

Dec 5 2020 by Niloofar Piri, MD

14-year-old female with 1q21.1 microdeletion syndrome and behavioral, intellectual, and systemic abnormalities, including congenital microcornea, iris coloboma, and chorioretinal and optic nerve coloboma presented with decreased vision. Right eye fundus taken with RetCam shows coloboma with retinal detachment. (Left eye showed white cataract with funnel RD on B-scan).

Photographer: Niloofar Piri MD, Douglas Snyder MD

Condition/keywords: chorioretinal coloboma, optic nerve coloboma, retinal detachment

Jan 20 2021 by Niloofar Piri, MD

Prepapillary congenital vascular loop in an asymptomatic patient.

Photographer: Lisa Breeding, Saint Louis University

Condition/keywords: vascular loop, venous loop

Feb 2 2021 by Niloofar Piri, MD

43-year-old female with large oval chorioretinal scar in posterior pole with heavy RPE hyperplasia and history of hydrocephalus s/p VP shunt since birth. Findings are consistent with congenital toxoplasmosis.

Condition/keywords: congenital toxoplasmosis

Feb 2 2021 by Niloofar Piri, MD

#1 16-year-old male with abnormal temporal peripheral telangiectatic and aneurysmal vascular lesions associated with hard exudate deposition posteriorly. Vision 20/20. Stage II Coats' disease.

Condition/keywords: Coats' disease, Leber's miliary aneurysm

Feb 25 2021 by Niloofar Piri, MD

Collage color photo and FA image of the same patient with Coats' Disease demonstrating telangiectatic aneurysmal lesions in the temporal periphery, associated with hard exudate deposition posteriorly. FA (AV phase) demonstrating hyperfluorescent aneurysmal lesions as well as peripheral capillary non perfusion. Note the posterior hypofluorescence where the hard exudates are located.

Condition/keywords: Coats' disease, congenital retinal telangiectasis, retinal telangiectasia

Feb 25 2021 by Niloofar Piri, MD

Color fundus photograph and SD OCT of a 6-year-old patient with optic disc pit associated with large retinoschisis involving the entire macula. SD OCT demonstrating large retinoschisis with ILM draping centrally giving it the appearance of pseudohole on the corresponding central area of color photo. Vision 20/80

Photographer: Lisa Breeding, St Louis University

Condition/keywords: maculopathy, optic disc

Mar 5 2021 by Niloofar Piri, MD

Heterochromia associated with Fuchs' heterochromic iridocyclitis in the left eye of a 63-year-old patient. Notice the green color of the left iris resulting from diffuse iris atrophy.

Photographer: Douglas Snyder, MD. St. Louis University

Condition/keywords: Fuchs, Fuchs' heterochromic cyclitis, heterochromia

Jul 22 2021 by Niloofar Piri, MD

Montage wide field fundus photograph of a 55-year-old male who presented with late onset night blindness and peripheral vision loss for one year. His central vision is preserved at 20/25. Fundus photograph demonstrates waxy pallor of the optic nerve, arterial narrowing, and peripheral RPE atrophy outside the arcades with bony spicules.

Photographer: Niloofar Piri, MD

Condition/keywords: retinitis pigmentosa

Jul 22 2021 by Niloofar Piri, MD

Montage wide field fundus photograph of the left eye of the same patient. 55-year-old male presented with late onset night blindness and peripheral vision loss for one year. Central vision is preserved at 20/25. ERG demonstrated extinguished rod function, and minimally diminished cone function. Waxy pallor of the optic nerve, arterial narrowing, and peripheral bony spicules are the classic triad of RP which are demonstrated in the photograph.

Photographer: Niloofar Piri, MD

Condition/keywords: retinitis pigmentosa

Aug 5 2021 by Niloofar Piri, MD

Ultrawide field fundus photograph of a 79-year-old patient who was incidentally found to have extensive bear track lesions in both eyes. Left eye was treated for NVG in the past and bear tracks were only visible temporal to the macula where there was no laser scars. He was referred to be seen by gastroenterologist and have a colonoscopy given high association with FAP and Gardner's syndrome.

Photographer: Jacob Grodsky, MD, St. Louis University

Condition/keywords: bear tracks, congenital hypertrophy of the retinal pigment epithelium (CHRPE)

Apr 30 2022 by Niloofar Piri, MD

61 yo male with PMH of longstanding schizophrenia since 20s with secondary intellectual disability presented with decreased vision following a recent stroke. He was found to have bilateral chorio-retinal atrophy involving posterior pole with scalloped edges and coin shaped atrophic area at margins extending into mid-periphery, diagnosis most concerning for intermediate stage thioridazine toxicity given the history. Mother could find handwritten prescriptions from 1990s when he was on Thioridazine 800 mg daily for unknown period of time. Patient had better vision in the left eye which was affected by recent stroke and prompted him to seek medical care. Fundus photograph of the right eye is demonstrated here.

Photographer: Jacob Grodsky, MD

Condition/keywords: drug toxicity, thioridazine toxicity, toxic retinopathy

Aug 21 2022 by Niloofar Piri, MD

Fundus photograph of the right eye in a 43 yo patient demonstrating a flat choroidal nevsu with halo nasal to the optic nerve

Photographer: Andrew Polk, MD

Condition/keywords: Choroidal nevus, nevus with halo

Sep 7 2022 by Niloofar Piri, MD

Xanthocoria secondary to total exudative RD in Coats' disease. Yellow color is secondary to extensive subretinal exudates.

Photographer: Jacob Grodsky, MD

Condition/keywords: Coats' disease, Xanthocoria

Sep 7 2022 by Niloofar Piri, MD

Total exudative RD with extensive subretinal exudates and peripheral telangiectatic vascular anomalies in stage 4 Coats's disease. Patient is a 12 yo who presented with severe eye pain and neovascular glaucoma secondary to the above.

Photographer: Jacob Grodsky, MD

Condition/keywords: Coats' disease

Sep 13 2022 by Niloofar Piri, MD

Fundus photograph of the left eye demonstrating mid-peripheral traction retinal detachment not involving the fovea in a case of advanced proliferative diabetic retinopathy.

Photographer: Jillian Baker, DO, Saint Louis University

Condition/keywords: proliferative diabetic retinopathy (PDR), tractional retinal detachment, TRD

Nov 18 2022 by Niloofar Piri, MD

21 yo female presented with decaresed central vision and scotoma immediately after severe vomiting. Color fundus phtograph demonstrates large sub ILM layered hemorrhage in the macula consistent with valsalva retinopathy. Notice the sacttered blot retinal hemorrhages in mid-periphery.

Photographer: Rocio Bentivegna, MD, Saint Louis University

Condition/keywords: sub ILM hemorrhage, valsalva retinopathy

Nov 18 2022 by Niloofar Piri, MD

Sudden vision loss immediately after severe vomiting. Color fundus photo demonstrates large sub ILM hemorrhage consistent with valsalva retinopathy.

Photographer: Sean Kelso, Saint Louis University

Condition/keywords: SUB ILM hemorrhage, sub internal limiting membrane haemorrhage, valsalva retinopathy

Nov 29 2022 by Niloofar Piri, MD

Fundus photograph of the left eye in a 58 yo male with rod cone dystrophy. He presented with night blindness and peripheral vision loss since youth and recent decrease in central vision for the past 10 years. Notice waxy pallor of the nerve, severe arterial narrowing and chorioretinal atrophy mainly around the arcades as well as posterior pole along with RPE hyperplastic changes and atrophy. RPE atrophy in midperiphery has coin shaped appearance. FAF has characteristic appearance (uploaded separately) He has one pathogenic variants of both CEP290 and PRPH2 genes.

Photographer: Sean Kelso, Saint Louis University

Condition/keywords: hereditary retinal deg, hereditary retinal dystrophy, Rod cone dystrophy

Nov 29 2022 by Niloofar Piri, MD

Fundus autofluorescence of the left eye in a 58 yo male with rod cone dystrophy. He presented with night blindness and peripheral vision loss since youth and recent decrease in central vision for the past 10 years. Notice multiple coin shaped hypoautofluorescent pacthes within central 20 degrees which are coalescing centrally. (fundus photo uploaded separately) He has one pathogenic variants of both CEP290 and PRPH2 genes.

Photographer: Sean Kelso, Saint Louis University

Condition/keywords: hereditary retinal degeneration, hereditary retinal dystrophy, rod cone dystrophy

Mar 5 2023 by Niloofar Piri, MD

Fundus photograph of the right eye demonstrating patches of isolated myelinated nerve fiber layers along inferior arcade as well as nasal retina

Photographer: Sean Kelso, Saint Louis University

Condition/keywords: myelinated nerve fiber layer, myelinated nerve fibers

Mar 31 2023 by Niloofar Piri, MD

Fundus autofluorescence image of the right eye in a highly myopic Caucasian patient who was screened for plaquenil toxicity elsewhere for 15 years. Medicine was stopped 3 years ago. She presented to us with deteriorationg central vision and scotoma for the past 3 years. FAF demonstrtaes classic symmetric bull's eye pattern of hypoautofluorescence in parafoveal area both eyes with some extension to the arcades, which is the result of severe plaquenil toxicity. Notice the hyperAF area surrounding the bull'e eye which is demonstarting stressed RPE cells filled with Lipofuscin. This area will likely turn to a larger hypoAF later. It is critical to diagnose it early to prevent the ongoing damage and loss of RPE and photoreceptors from the long term deposited medicine in RPE cells.

Photographer: Sean Kelso, Saint Lousi University

Condition/keywords: bull's eye atrophy, bull's eye maculopathy, hydroxychloroquine toxicity, plaquenil toxicity

Mar 31 2023 by Niloofar Piri, MD

Fundus autofluorescence of both eyes in a diabetic patient with Mac tel type 2 demonstrating classic temporal foveal hyperAF.

Condition/keywords: idiopathic macular telangiectasia, Mac Tel type 2, macular telangiectasia type 2

May 6 2023 by Niloofar Piri, MD

Montage fundus photograph of the left eye in a patient with sarcoidosis demonstrating peripheral inactive multifocal chorioretinal scars after systemic immunomodulatory therapy.

Photographer: Sean Kelso, Saint Lousi University

Condition/keywords: multifocal chorioretinitis (MCP), multifocal choroiditis, sarcoid uveitis, sarcoidosis

May 12 2023 by Niloofar Piri, MD

Ultrawide fundus photograph of the left eye demonstrating extensive peripheral hemorrhagic exudative detachment in a 79 yo Caucasian female with prior history of non-exudative AMD. Recent diagnosis of Acute myeloid leukemia with low platelet count which might have contributed to the above presentatuon. Please note the temporal subretinal hemorrhage as well as RPE atrophy and hyperplasia in the macula.

Photographer: Rocio Bentivegna, MD, Saint Louis University; Jessica Maddox, COA, Saint Louis University

Condition/keywords: peripheral exudative hemorrhagic chorioretinopathy (PEHCR)

May 24 2023 by Niloofar Piri, MD

Montage fundus photograph of the left eye with end stage Sympathetic Ophthalmia, demonstrating optic nerve pallor, severe arterial attenuation, extensive chorioretinal atrophy (sclera is exposed in most areas), and peripheral RPE hyperplasia. Patient is a 50 yo Asian female with history of multiple vitrectomies due to retinal detachment and loss of vision who developed Sympathetic Ophthalmia in the other eye. This picture is 20 years after the disease process started, with end stage picture and HM vision.

Photographer: Sean Kelso, Saint louis university

Condition/keywords: sympathetic ophthalmia

Oct 4 2023 by Niloofar Piri, MD

Progression fundus photograph images of a 22 yo female with Valsalva retinopathy secondary to violent emesis. Note the sub ILM layered hemorrhage and gradual decrease then disappearance over time. Last image is at 6 month follow up with 20/20 vision. Of note the silhouette of ILM separation is still visible.

Condition/keywords: valsalva retinopathy

Oct 22 2023 by Niloofar Piri, MD

Fundus photograph of right eye of a patient from Liberia demonstrating multiple birefringent yellow green crystalline deposits in the fovea. Please notice the partially fibrosed NVE inferiorly. The disease has been shown to be associated with vascular disorders including diabetic retinopathy.

Photographer: Niloofar Piri, MD

Condition/keywords: crystalline maculopathy, crystalline retinopathy, West African Crystalline maculopathy

Oct 22 2023 by Niloofar Piri, MD

Wide field fundus photograph of the right eye of the same patient from Liberia demonstrating birefringent crystals in the fovea. Notice the partially fibrosed NVE inferiorly in the macula.

Photographer: Niloofar Piri, MD

Condition/keywords: crystalline maculopathy, crystalline retinopathy, West African Crystalline Maculopathy

Nov 12 2024 by Niloofar Piri, MD

Fundus photograph of 33 year old Caucasian male with poorly controlled diabetes type 1 who presented with traction retinal detachment involving the macula with VA CF 2ft (Left side panel). Three months after surgery vision is 20/60 and retina is attached (Right side panel). HbA1c is much better controlled now.

Photographer: Stefan Raev, COT; Saint Louis University

Condition/keywords: Traction retinal detachment, TRD