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Jul 3 2020 by Dhaivat Shah

A 30-year-old young male presented with drop in vision in right eye since 1 year (6/60). Fundus examination revealed choroidal hemangioma superotemporal to macula. Choroidal hemangioma is an unusual benign vascular tumor of the choroid. It can be circumscribed solitary or diffuse tumor with the later having other systemic associations. Circumscribed choroidal hemangiomas (CCHs) are usually unilateral, unifocal hamartomatous vascular tumor affecting people in second to fourth decade. It appers as round to oval, orangish-red mass in posterior pole with smooth homogenous surface mostly present in macular and peripapillary area. Hyperopic shift is seen in sub-foveal tumors in contrast to para-foveal ones which are usually asymptomatic or present with metamorphopsia or photopsia and diminished vision secondary to exudative retinal detachment. B-scan shows highly reflective tumor without any shadowing or acoustic solidity with high anterior A scan spike. EDI-OCT here depicts a smooth gently sloping choridal mass with compressed choriocapillaries and enlarged medium and large choroidal vessels. Over a period of time structural abnormalities of the outer retina can be visualised. Ancillary testing using Fluorescein Angiography shows lacy hyper-fluorescence during early arterial phase followed by increased hyper-fluorescence due to progressive profuse leakage from pin point foci during arterial and venous phase. Indocyanine green angiography shows lacy diffuse fluorescent tumor in early phase followed by hypo-fluorescent tumor due to dye wash out in late phase. Intrinsic auto-fluorescence is also seen in CCHs from lipofuscin and fresh sub-retinal fluid. Tumor is relatively hyper-intense with respect to vitreous in T1-weighted images in iso-intense in T2-weighted images of MRI. Asymptomatic cases need no treatment, while patients showing vision loss with presence or absence of exudative retinal detachment can be treated with photodynamic therapy which is preferred treatment due to site specific action. Selective occlusion of choroidal neovascularization can be achieved while the neurosensory retinal layers and Bruch membrane are almost unaffected, leaving retinal function intact. Green or rarely red wavelength laser photocoagulation is used to create a chorioretinal adhesion and resolve the SRF. Other treatment modalities include Transpupilary thermotherapy, external beam irradiation, proton beam therapy, brachytherapy and gamma knife.

Photographer: Miss Deepika Nagle

Imaging device: Zeiss

Condition/keywords: B scan ultrasound, choroidal hemangioma, fundus photograph, optical coherence tomography (OCT), photodynamic therapy

Jun 27 2020 by SANDEEP KUMAR

A 59-year-old man with DM for 18 years operated for mature cataract. Post op left eye had a visual acuity of 20/80. Wide field swept source OCTA revealed gross vessel wipe out in inferior hemi quadrant with branching out neovascular frond inferior to disc with terminal loops, The patient underwent Anti VEGF injection followed by OCTA guided sectoral retinal photocoagulation.Image J software used here to generate reverse image that sharply delineates the non perfusion area.

Photographer: Sandeep Kumar

Imaging device: Optical coherence tomography system Zeiss Plex Elite 9000

Condition/keywords: hemi CRVO, neovascularization elsewhere (NVE)

Jun 27 2020 by Aayesha Khanum

Fundus photograph showing branch retinal vein occlusion with macular edema.

Photographer: Ravikrishna, Puttaswamy

Imaging device: Heidelberg Spectralis

Condition/keywords: branch retinal vein occlusion (BRVO)

Jun 27 2020 by Aayesha Khanum

Multicolor image and infra-red image showing fibrovascular pigment epithelial detachment (PED),FFA and ICG confirms the diagnosis., SD-OCT shows notched fibrovascular PED

Photographer: Puttaswamy,Ravikrishna

Imaging device: Heidelberg Spectralis

Condition/keywords: neovascular age-related macular degeneration (AMD)

Jun 27 2020 by Thirumalesh Mochi Basavaraj

Fundus photo showing eclipse burn, Inset OCT picture shows loss of photoreceptor layer.

Photographer: Ravikrishna, Puttaswamy

Imaging device: Heidelberg Spectralis

Condition/keywords: solar retinopathy

Jun 27 2020 by Thirumalesh Mochi Basavaraj

Multiple drusens seen at macula, OCT shows sub RPE deposits of hyper-reflective material.

Photographer: Ravikrishna, Puttaswamy

Imaging device: Heidelberg Spectralis

Condition/keywords: age-related macular degeneration (AMD)

Jun 27 2020 by Thirumalesh Mochi Basavaraj

23-year-old asymptomatic female, came for routine examination. Inset shows OCT image with hyperreflective lesion scattered throughout the retina, choroidal sclerosis can also be noted.

Photographer: Ravikrishna, Puttaswamy

Imaging device: Heidelberg Spectralis

Condition/keywords: crystalline retinopathy

Jun 27 2020 by Aayesha Khanum

Regressed CRVO with severe collateral at disc

Photographer: Ravikrishna, Puttaswamy

Imaging device: Heidelberg Spectralis

Condition/keywords: central retinal vein occlusion (CRVO), collaterals

Jun 26 2020 by SANDEEP KUMAR

A 59-year-old man with DM for 18 years operated for mature cataract. Post op left eye had a visual acuity of 20/80. Wide field swept source OCTA revealed gross vessel wipe out in inferior hemi quadrant with branching out neovascular frond inferior to disc with terminal loops, The patient underwent Anti VEGF injection followed by OCTA guided sectoral retinal photocoagulation.Image J software used here to generate reverse image that sharply delineates the non perfusion are

Photographer: Sandeep Kumar

Imaging device: Optical coherence tomography system Zeiss Plex Elite 9000

Condition/keywords: hemi CRVO

Jun 25 2020 by Evan N Dunn, MD

40 year old male with X-linked juvenile retinoschisis. Genetic testing was positive for a pathogenic variant in the RS1 gene.

Photographer: Steve Morris

Condition/keywords: x-linked retinoschisis (XLRS)

Jun 25 2020 by Evan N Dunn, MD

40-year-old male with X-linked juvenile retinoschisis. Genetic testing was positive for a pathogenic variant in the RS1 gene.

Condition/keywords: x-linked retinoschisis (XLRS)

Jun 25 2020 by Thirumalesh Mochi Basavaraj

Fundus photograph (montage) of 9-year-old child with macular exudation. Telangiectic vessels seen. Please note saccular and beaded aneurysmal dilatation of vessels temporally.

Photographer: Puttaswamy

Imaging device: DRI OCT Triton SSOCT- Topcon

Condition/keywords: Coats' disease, idiopathic macular telangiectasia, macular exudates

Jun 24 2020 by RANJITH P C

Fundus photograph of a 50-year-old male with meningo encephalitis.

Photographer: Dr Ranjith PC, al salama eye hospital

Imaging device: Ziess

Condition/keywords: optic disc edema, Paton's lines

Jun 23 2020 by Thirumalesh Mochi Basavaraj

Intraoperative pictures showing bacterial colonies, lab confirmed gram positive cocci(inset).

Imaging device: Leica microsurgery microscope

Condition/keywords: endophthalmitis, intraoperative

Jun 21 2020 by Dhaivat Shah

Myelinated nerve fiber layer (mNFL) is a benign clinical entity that results from an embryologic developmental anomaly. Myelination along the visual pathway is noted around the eighth month of gestation, and typically reaches the posterior globe around the time of birth with virtually all fibers reaching complete myelination by age 7 months till the lamina cribrosa. Sometimes, due to altered neuro hormonal signals, this process of myelination extends past the lamina cribrosa and is visible on fundus examination as distinct white patches on the inner retinal surface. On infrared and red-free imaging, mNFL appears white, which is likely due to the high lipid content of myelin. Myelin blocks detection of underlying fluorescent material, thus appearing dark on fundus autofluorescence. On optical coherence tomography , it appears as a thickened and hyperreflective retinal nerve fiber layer. mNFL is typically benign but can be mistaken for other potentially serious conditions like neoplastic infiltration or infection. Hence, it is crucial to recognize the benign nature of mNFL to avoid superfluous medical testing.

Photographer: Ms Srishti Sharma

Imaging device: Choithram Netralaya

Condition/keywords: myelinated nerve fibers

Jun 19 2020 by Stephanie Burke

85-year-old male with ischemic CRVO.

Photographer: Stephanie Burke, CRA, OCT-C

Condition/keywords: central retinal vein occlusion (CRVO), ischemia, macular edema, ultra-wide field imaging

Jun 18 2020 by Renata Garcia Franco, Md

Female 25-year-old with serous retinal detachment in both eyes.

Photographer: Fatima Hernandez

Imaging device: Visucam

Condition/keywords: Vogt-Koyanagi-Harada

Jun 18 2020 by Renata Garcia Franco, Md

Female 25-year-old with serous retinal detachment in both eyes.

Photographer: Fatima Hernandez

Imaging device: Visucam

Condition/keywords: Vogt-Koyanagi-Harada

Jun 17 2020 by Sophia El Hamichi, MD

A 75-year-old male treated with brachytherapy for choroidal melanoma in 2012. He now has interesting OCT findings in the area of radiation retinopathy, suggesting fibrovascular changes.

Photographer: Belinda Rodriguez, Murray Ocular Oncology and Retina, Miami

Condition/keywords: choroidal melanoma, fibrovascular change, radiation retinopathy

Jun 15 2020 by Aayesha Khanum

Fundus photo of diagnosed case of pulmonary TB.

Photographer: Puttaswamy

Imaging device: DRI OCT Triton swept source OCT- Topcon

Condition/keywords: abscess, choroidal tuberculoma