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May 8 2021 by Jazli Tan

Optical Coherence Tomography (OCT) of a 31-year-old man with a traumatic macular hole from a badminton racket injury. OCT with enhanced depth imaging showed full thickness macular hole with subretinal fluid.

Condition/keywords: traumatic macular hole

May 8 2021 by Jazli Tan

Fundus photograph of a 31-year-old man with a traumatic macular hole from a badminton racket injury. Fundoscopic examination revealed macular hole with associated sub-retinal, sub-retinal pigment epithelium, and sub-hyaloid bleed temporal to macula. Myelinated nerve fibre layer of the optic disc was noted superiorly with splinter hemorrhages.

Condition/keywords: traumatic macular hole

May 8 2021 by Kushal S Delhiwala, MBBS, MS, FMRF,FICO, FAICO

Fundus photograph of 47-year-old phakic female with right eye proliferative diabetic retinopathy associated tractional retinal detachment involving macula. Vitrectomy was planned with pre-op anti-VEGF before 4 days. Pseudocolor fundus image (A) shows extensive triangular vascular proliferation (FVP) around disc and macula (white arrows). Fundus image (B) shows significant FVP regression following anti-VEGF.

Photographer: Kushal Delhiwala, Netralaya superspeciality eye hospital, Ahmedabad, Gujarat,India

Imaging device: Optos Daytona

Condition/keywords: anti-VEGF, fibrovascular proliferation, intravitreal bevacizumab, pre-op, proliferative diabetic retinopathy (PDR), tractional retinal detachment

May 7 2021 by Dhaivat Shah

Retinal angiomatous proliferation (RAP) is a distinct variant of neovascular age-related degeneration (AMD) that usually initiates at the retina and progresses posteriorly into sub retinal space. In most recent study, it was suggested that angiogenesis may begin in the retina, choroid, or both, and introduced a new name for the process: Type 3 neovascularization. The frequency of RAP has been studied in many studies, with figures ranging from 10% to 21% of exudative AMD. Clinically, three stages were originally described as intraretinal neovascularization (IRN), subretinal neovascularization (SRN), choroidal neovascularization (CNV). RAP predominantly intraretinal hard exudates, and intra/pre retinal hemorrhages along with intraretinal edema, associated pigment epithelial detachment beneath it, at times retinochoroidal, retino-retinal anastomosis. Apart from conventional OCT, FFA and ICG, OCT-A has now been used primarily as a tool in the diagnosis RAP. Here we present imaging of a 30-year-old young male diagnosed as RAP stage 3 (Type 3 CNVM). Patient was started on intravitreal anti-VEGF monotherapy therapy.

Photographer: Choithram Netralaya Indore

Condition/keywords: retinal angiomatous proliferation (RAP)

May 6 2021 by Priya Rasipuram Chandrasekaran, MBBS, DO, DNB, FRCS

This is the fundus photo of a patient with Ozurdex implant containing 0.7 m of dexamethasone given for gross cystoid macular edema in multifocal choroidtitis.

Condition/keywords: dexamethasone implant

May 5 2021 by Deependra Vikram Singh, MD

Fundus photographs and OCT scans of a 73-year-old non-smoker Indian male who presented to our retina clinic in 2013 with blurred vision in left eye for past 2 weeks. BCVA was 20/20 in right eye and 20/40 in left eye. Slit lamp exam was unremarkable for both eyes with no cells in aqueous or anterior vitreous. Fundus examination revealed creamy yellow choroidal lesions in both eyes. Lesion in right eye was one disc diameter (DD) in size and was located close to fovea (Fig-1a). Lesion in the left eye was bigger with a size of 2 DD located superior to fovea (Fig-1b). OCT scan for left eye revealed neurosensory detachment involving fovea (Fig-1c). Fundus fluorescein angiography was inconclusive for right eye and showed late hyper fluorescence the choroidal lesion in left eye. Patient underwent detailed systemic work up for malignancy that revealed primary lung non-small cell carcinoma. He had widespread metastasis affecting liver and brain. Palliative chemotherapy and radiotherapy were initiated 4 weeks after he presented to us. The choroidal lesions show progression on fundus picture and OCT scans done at 4 weeks follow up after initial presentation (Fig – 1d, e, f). The lesions in both eyes show regression at 4 weeks and 12 weeks follow up after initiation of therapy. Unfortunately, patient succumbed at 13 weeks follow up due to disease progression. The case demonstrates rare bilateral choroidal metastasis from primary lung cancer and also highlights that lesions can be asymptomatic till they develop neurosensory detachment as evident from asymptomatic lesion in right eye despite proximity to fovea and symptomatic lesion in left eye with NSD.

Photographer: Deependra Vikram Singh, Eye-Q Superspecialty Eye Hospitals, Gurugram

Imaging device: Topcon

Condition/keywords: choroidal mass, choroidal metastasis

May 5 2021 by Priya Rasipuram Chandrasekaran, MBBS, DO, DNB, FRCS

A 31-year-old male presented with a decreased vision of 20/125 N24 with -6.50 DS/-3.50 cyl 90 in the left eye. Fundus examination revealed peripapillary MNF progressing superiorly, obscuring disc and vessels and sparing the macula. OCT of ONH showed hyper reflective NFL and an abrupt ending of RPE and inner retinal layers (IRL) with underlying shadowing at the beginning of hyper reflectivity. The absence of photoreceptor integrity line (PIL) in the macula is believed to cause refractory amblyopia in such patients.

Condition/keywords: myelinated nerve fibers

May 4 2021 by Hannah Keller

Anterior Uveitis OPTOS on 81-year-old male.

Photographer: Hannah Keller, Retina Specialists of Michigan

Condition/keywords: anterior uveitis, hypertensive retinopathy, OD, Optos

May 4 2021 by Rafael Reis Pereira, MD

A 31-year-old patient with a complaint of photophobia and low visual acuity OD in the previous three weeks. BCVA was 20/60 and 20/20 The fundus examination revealed a placoid white lesion in the posterior pole and vitreous cells in the right eye. The left eye was unremarkable. Fluorescein angiography reveals hyperfluorescent plaque with distinctive “leopard spots” hypofluorescence.

Imaging device: Opto California

Condition/keywords: acute syphilitic posterior placoid chorioretinitis

May 4 2021 by Priya Rasipuram Chandrasekaran, MBBS, DO, DNB, FRCS

Fundus photo of a 34-year-old male showing bilaterally symmetrical atrophy of retinal pigment epithelium (RPE) and choriocapillaris involving the fovea and highlighting the underlying large choroidal vessels. OCT macula shows atrophy of the outer retinal layers up to the external limiting membrane along with thinning of RPE and Bruch's membrane complex. Rosette - like hyperreflective structures causing retinal elevation at the border of atrophic area (yellow arrows) are seen categorizing this into stage 4 disease.

Condition/keywords: central areolar choroidal dystrophy (CACD)

May 4 2021 by Priya Rasipuram Chandrasekaran, MBBS, DO, DNB, FRCS

This fundus photo and montage shows pigmentary changes with fibroglial proliferation of the disc and macula in a 36-year-old male following injury with an iron chain. This is usually following a high velocity non-penetrating missile or blast injury categorized as coup injury and can be both direct or indirect. The layers affected are the highly inelastic Bruch’s membrane with choriocapillaris and retinal pigment epithelium in contrast to the highly elastic retina and sclera. The high impact injury causes full thickness defect in the retina, Bruch’s membrane and choroid leading to retraction of the retina and choroid, leaving the intact bare sclera behind. Pathology included defects in the Bruch’s membrane and choroid, and extensive photoreceptor loss with hyperplasia of retinal pigment epithelium. Over the weeks, loose fibrous tissue gets replaced by dense connective tissue leading to scarring between retina and choroid as seen in our patient. The background shows fundus albipunctatus.

Condition/keywords: chorioretinitis sclopetaria

May 4 2021 by Priya Rasipuram Chandrasekaran, MBBS, DO, DNB, FRCS

This is the fundus photo of a 52-year-old male taken within 6 hours and after 24 hours of sudden onset of inferior field loss. The photo shows prominence of retinal edema in the region of arterial occlusion as time passes by. The optical coherence tomogram scan taken vertically through the normal and the involved area shows thickening and hyper reflectivity of retinal nerve fiber layer and decreased reflectivity of the retinal layers beneath it (white arrow). Fundus fluorescein angiography shows complete non-filling of the artery in the early phase with slow filling in the late phase and highlighting the embolus.

Condition/keywords: branch retinal artery occlusion (BRAO)

May 4 2021 by Priya Rasipuram Chandrasekaran, MBBS, DO, DNB, FRCS

This is the fundus photo of a 10-year-old girl showing RC coloboma along the infero nasal retina and involving the disc. This belongs to grade 4 of Ida Mann’s classification and grade 5 of Lingam Gopal’s classification of RC coloboma. The optic disc has no cup and BV for superior fundus emanates from superior part of optic disc and that for inferior fundus in the colobomatous area from multiple points. The blood vessels are discontinuous and are cork screw shaped.

Condition/keywords: chorioretinal coloboma

Apr 30 2021 by Shivani Reddy, MD

This is a fluorescein angiogram image capturing a beautiful example of different stages of venous beading in diabetic retinopathy all in one frame. This patient also has various microangiopathic findings including microaneurysms, venous loops and capillary dropout. This patient is a 41 y/o male with a history of type 1 diabetes, presenting for his first eye exam in years.

Imaging device: Optos FA

Condition/keywords: capillary dropouts, nonproliferative diabetic retinopathy, proliferative diabetic retinopathy (PDR), retinal ischemia, venous beading

Apr 30 2021 by ARVIND JAIN M

A 26-year-old gentlemen came with complains of defective vision in both eyes since childhood. His BCVA was right eye 5/60 and left eye 6/60. His anterior segment examination showed no abnormality with posterior segment examination showed both eyes (1a and 1b) greyish white elevated lesion involving the macula with thick fibrotic epiretinal membrane causing the macular drag temporally in right eye and supero-temporally in left eye. (2a and 2b) showing the thick ERM with the hamartoma of the retina and RPE.

Photographer: DR ARVIND JAIN, ARAVIND EYE HOSPITAL, COIMBATORE,INDIA

Condition/keywords: combined hamartoma, congenital hypertrophy of the retinal pigment epithelium (CHRPE), epiretinal membrane (ERM), retinal pigment epithelium (RPE) hamartoma

Apr 29 2021 by William G. Campbell, MD

Left wide-field fundus photograph of a 50-year-old male with normal visual acuity, but who has always been aware of a clear round circle in his vision.

Photographer: Marina Pascoe, Melbourne Retina Associates, Victoria, Australia

Condition/keywords: congenital anomaly

Apr 29 2021 by Fong May Chew, FRCOphth, MBBS, BSc

Optos pictures of a 56-year-old man who presented with a giant retinal tear who extending from 7-12 o clock with a separate horseshoe tear at 1 o clock. Treated with pneumatic retinopexy.

Photographer: Hesham Hamli

Condition/keywords: giant retinal tear, pneumatic retinopexy, retinal detachment

Apr 29 2021 by Giselle DeOliveira

Infared photograph of 30-year-old male with tortuous retinal vessels .

Photographer: Giselle DeOliveira

Imaging device: Heidelberg Spectralis

Condition/keywords: tortuous vessels

Apr 29 2021 by Giselle DeOliveira

Fluorescein image of 2-year-old female with familial exudative vitrepretinpoathy detachment touching the lens.

Photographer: Giselle DeOliveira

Imaging device: Retcam

Condition/keywords: familial exudative vitreoretinopathy (FEVR)

Apr 28 2021 by Ambar Faridi, MD

80-year-old woman with neovascular age-related macular degeneration with interval resolution of large subretinal hemorrhage and vascular exudation followed over time.

Photographer: Jennifer Tu-Bui, VA Portland Health Care System

Condition/keywords: neovascular age-related macular degeneration (AMD), reabsorbing subretinal hemorrhage