• Not All Vitreous Seeding Represents Malignancy: Case of Melanocytoma

    Nov 18 2019 by Sophia El Hamichi, MD

    Large optic disc melanocytoma with surrounding pigment dispersion. It is a benign lesion. The main differential in this case is melanoma with vitreous seeding.

    Condition/keywords: melanocytoma, melanoma, vitreous seeding

  • Diabetic TRD OS - FA 1 Min

    Nov 17 2019 by John S. King, MD

    28-year-old white male with poorly controlled Type 1 DM, with a history of non-compliance with follow-ups, was referred with for DR with CME OS, and 3 weeks decrease vision OS. Va cc was 20/15 OD and HM OS. IOP 18/14. No NVI OU. Posteriorly, the right eye had macular exudates, no NVD, and a large area of NVE along the IT arcade. The left eye large NV plaque around disc, wrapping macula, with total RD with a posterior funnel appearance. The FA in the left eye showed severe peripheral and macular ischemia with diffuse leakage from a fibrovascualr plaque.

    Photographer: Adriana Shelby

    Imaging device: Optos CA

    Condition/keywords: diabetic traction detachment, open funnel RD

  • Diabetic TRD - Photos OS

    Nov 17 2019 by John S. King, MD

    28-year-old white male with poorly controlled Type 1 DM, with a history of non-compliance with follow-ups, was referred with for DR with CME OS, and 3 weeks decrease vision OS. Va cc was 20/15 OD and HM OS. IOP 18/14. No NVI OU. Posteriorly, the right eye had macular exudates, no NVD, and a large area of NVE along the IT arcade. The left eye large NV plaque around disc, wrapping macula, with total RD with a posterior funnel appearance. The FA in the left eye showed severe peripheral and macular ischemia with diffuse leakage from a fibrovascualr plaque.

    Photographer: Adriana Shelby

    Imaging device: Optos CA

    Condition/keywords: diabetic traction detachment, open funnel RD

  • Choroidal Hemangioma: OCT One Month (L) and Two Months (R) Since PDT

    Nov 17 2019 by John S. King, MD

    67-year-old white male with 6 days of decreased vision and known history of choroidal hemangioma, who had received PDT years ago for symptomatic SRF, had recurrence of SRF. PDT was applied to the lesion and one month later there is less subfoveal SRF, and vision has increased to 20/50 from 20/150. One month later the OCT shows that SRF continues to decrease and vision has improved to 20/40.

    Condition/keywords: choroidal hemangioma

  • Moyamoya: Photo OD of an Acute CRAO with CRA Sparing

    Nov 17 2019 by John S. King, MD

    60-year-old white female presented with five days of acute vision loss in the right eye. She was seen initially by referring doctor after hours five days ago and diagnosed with a CRAO and sent to ED to be evaluated stroke team. Right ICA was 100% closed but completely bypassed. She called four days later c/o redness and eye pain; at this point prominent iris vessels were seen, and she was sent to us. Her background history includes a diagnosis of moyamoya (underwent bilateral cerebral artery bypass 2015); atorvastatin for hypercholesterolemia; ASA; no hx of HTN or heart disease. She had a scleral buckle repair OD in 2017 and later developed a thick ERM, which was repaired in 2018; on her previous visit her acuity was noted at 20/40. On presentation her visual acuity was HM OD and 20/15 OS. IOP was 8 OD and 10 OS. There were prominent iris vessels in the right eye, no cell or flare, and an IOL. The posterior segment exam showed diffuse retinal whitening with attenuated vessels and boxcarring; there was sparing retinal whitening in a central area of the macula that appeared to be supplied by a cilio-retina artery. The FA showed very slow filling of the retinal vessels; there was some early perfusion secondary to the cilio-retinal artery. At 7 minutes there was still significant areas of non-perfusion, as well as macular ischemia. Avastin was administered, and one week later, PRP was performed. On the day PRP was performed, the irregular iris vessels had regressed completely. She said that she had a "sliver" of vision centrally in that eye; her acuity was CF 2' and IOP 12.

    Photographer: Brandon Peter

    Imaging device: Topcon

    Condition/keywords: central retinal artery occlusion (CRAO), cilioretinal sparing, moyamoya, neovascularization of iris (NVI)

  • Moyamoya: FA 52 Sec OD of an Acute CRAO with CRA Sparing

    Nov 17 2019 by John S. King, MD

    60-year-old white female presented with five days of acute vision loss in the right eye. She was seen initially by referring doctor after hours five days ago and diagnosed with a CRAO and sent to ED to be evaluated stroke team. Right ICA was 100% closed but completely bypassed. She called four days later c/o redness and eye pain; at this point prominent iris vessels were seen, and she was sent to us. Her background history includes a diagnosis of moyamoya (underwent bilateral cerebral artery bypass 2015); atorvastatin for hypercholesterolemia; ASA; no hx of HTN or heart disease. She had a scleral buckle repair OD in 2017 and later developed a thick ERM, which was repaired in 2018; on her previous visit her acuity was noted at 20/40. On presentation her visual acuity was HM OD and 20/15 OS. IOP was 8 OD and 10 OS. There were prominent iris vessels in the right eye, no cell or flare, and an IOL. The posterior segment exam showed diffuse retinal whitening with attenuated vessels and boxcarring; there was sparing retinal whitening in a central area of the macula that appeared to be supplied by a cilio-retina artery. The FA showed very slow filling of the retinal vessels; there was some early perfusion secondary to the cilio-retinal artery. At 7 minutes there was still significant areas of non-perfusion, as well as macular ischemia. Avastin was administered, and one week later, PRP was performed. On the day PRP was performed, the irregular iris vessels had regressed completely. She said that she had a "sliver" of vision centrally in that eye; her acuity was CF 2' and IOP 12.

    Photographer: Brandon Peter

    Imaging device: Topcon

    Condition/keywords: central retinal artery occlusion (CRAO), cilioretinal sparing, moyamoya, neovascularization of iris (NVI)

  • Moyamoya: FA 2 Min OD of an Acute CRAO with CRA Sparing

    Nov 17 2019 by John S. King, MD

    60-year-old white female presented with five days of acute vision loss in the right eye. She was seen initially by referring doctor after hours five days ago and diagnosed with a CRAO and sent to ED to be evaluated stroke team. Right ICA was 100% closed but completely bypassed. She called four days later c/o redness and eye pain; at this point prominent iris vessels were seen, and she was sent to us. Her background history includes a diagnosis of moyamoya (underwent bilateral cerebral artery bypass 2015); atorvastatin for hypercholesterolemia; ASA; no hx of HTN or heart disease. She had a scleral buckle repair OD in 2017 and later developed a thick ERM, which was repaired in 2018; on her previous visit her acuity was noted at 20/40. On presentation her visual acuity was HM OD and 20/15 OS. IOP was 8 OD and 10 OS. There were prominent iris vessels in the right eye, no cell or flare, and an IOL. The posterior segment exam showed diffuse retinal whitening with attenuated vessels and boxcarring; there was sparing retinal whitening in a central area of the macula that appeared to be supplied by a cilio-retina artery. The FA showed very slow filling of the retinal vessels; there was some early perfusion secondary to the cilio-retinal artery. At 7 minutes there was still significant areas of non-perfusion, as well as macular ischemia. Avastin was administered, and one week later, PRP was performed. On the day PRP was performed, the irregular iris vessels had regressed completely. She said that she had a "sliver" of vision centrally in that eye; her acuity was CF 2' and IOP 12.

    Photographer: Brandon Peter

    Imaging device: Topcon

    Condition/keywords: central retinal artery occlusion (CRAO), cilioretinal sparing, moyamoya, neovascularization of iris (NVI)

  • Moyamoya: FA 3:25 OD of an Acute CRAO with CRA Sparing

    Nov 17 2019 by John S. King, MD

    60-year-old white female presented with five days of acute vision loss in the right eye. She was seen initially by referring doctor after hours five days ago and diagnosed with a CRAO and sent to ED to be evaluated stroke team. Right ICA was 100% closed but completely bypassed. She called four days later c/o redness and eye pain; at this point prominent iris vessels were seen, and she was sent to us. Her background history includes a diagnosis of Moyamoya (underwent bilateral cerebral artery bypass 2015); atorvastatin for hypercholesterolemia; ASA; no hx of HTN or heart disease. She had a scleral buckle repair OD in 2017 and later developed a thick ERM, which was repaired in 2018; on her previous visit her acuity was noted at 20/40. On presentation her visual acuity was HM OD and 20/15 OS. IOP was 8 OD and 10 OS. There were prominent iris vessels in the right eye, no cell or flare, and an IOL. The posterior segment exam showed diffuse retinal whitening with attenuated vessels and boxcarring; there was sparing retinal whitening in a central area of the macula that appeared to be supplied by a cilio-retina artery. The FA showed very slow filling of the retinal vessels; there was some early perfusion secondary to the cilio-retinal artery. At 7 minutes there was still significant areas of non-perfusion, as well as macular ischemia. Avastin was administered, and one week later, PRP was performed. On the day PRP was performed, the irregular iris vessels had regressed completely. She said that she had a "sliver" of vision centrally in that eye; her acuity was CF 2' and IOP 12.

    Photographer: Brandon Peter

    Imaging device: Topcon

    Condition/keywords: central retinal artery occlusion (CRAO), cilioretinal sparing, moyamoya, neovascularization of iris (NVI)

  • Moyamoya: FA 7 Min OD of an Acute CRAO with CRA Sparing

    Nov 17 2019 by John S. King, MD

    60-year-old white female presented with five days of acute vision loss in the right eye. She was seen initially by referring doctor after hours five days ago and diagnosed with a CRAO and sent to ED to be evaluated stroke team. Right ICA was 100% closed but completely bypassed. She called four days later c/o redness and eye pain; at this point prominent iris vessels were seen, and she was sent to us. Her background history includes a diagnosis of Moyamoya (underwent bilateral cerebral artery bypass 2015); atorvastatin for hypercholesterolemia; ASA; no hx of HTN or Heart Disease. She had a scleral buckle repair OD in 2017 and later developed a thick ERM, which was repaired in 2018; on her previous visit her acuity was noted at 20/40. On presentation her visual acuity was HM OD and 20/15 OS. IOP was 8 OD and 10 OS. There were prominent iris vessels in the right eye, no cell or flare, and an IOL. The posterior segment exam showed diffuse retinal whitening with attenuated vessels and boxcarring; there was sparing retinal whitening in a central area of the macula that appeared to be supplied by a cilio-retina artery. The FA showed very slow filling of the retinal vessels; there was some early perfusion secondary to the cilio-retinal artery. At 7 minutes there was still significant areas of non-perfusion, as well as macular ischemia. Avastin was administered, and one week later, PRP was performed. On the day PRP was performed, the irregular iris vessels had regressed completely. She said that she had a "sliver" of vision centrally in that eye; her acuity was CF 2' and IOP 12.

    Photographer: Brandon Peter

    Imaging device: Topcon

    Condition/keywords: central retinal artery occlusion (CRAO), cilioretinal sparing, moyamoya, neovascularization of iris (NVI)

  • Vitamin A Deficiency Retinopathy - Initial Images - Late FA (R) and AF (L)

    Nov 17 2019 by John S. King, MD

    45-year-old female with a history of gastric bypass surgery, who was referred to Dr. Zocchi for as a possible choroidal dystrophy; patient had severe nyctalopia that had progressed over a year; acuity was 20/20 OU with normal IOP and A/C findings. The posterior segment showed multiple yellow-white punctate dots in the mid-periphery and periphery (see photo). Findings were consistent with probable vitamin A deficiency. Patient was started on Vit A, and levels were found to be very low. This is the initial images and the punctate spots are not detectable on the FA (no staining) or AF.

    Photographer: Shelly Blair

    Imaging device: Optos CA

    Condition/keywords: fleck retinopathy, malabsorption, nyctalopia, vitamin A deficiency, xerophthalmia

  • Vitamin A Deficiency Retinopathy - Initial Images on the Left and 5 Months Later on the Right

    Nov 17 2019 by John S. King, MD

    45-year-old female with a history of gastric bypass surgery, who was referred to Dr. Zocchi for as a possible choroidal dystrophy; patient had severe nyctalopia that had progressed over a year; acuity was 20/20 OU with normal IOP and A/C findings. The posterior segment showed multiple yellow-white punctate dots in the mid-periphery and periphery (see photo). Findings were consistent with probable vitamin A deficiency. Vitamin A levels in the serum were greatly reduced. Patient was started on Vit A weekly infusions and PO daily. A few months later the punctate spots had resolved (there are some drusen like deposits in far periphery) and her nyctalopia had reversed.

    Photographer: Brandon Peter (L Image) and Shelly Blair (R Image)

    Imaging device: Optos CA

    Condition/keywords: fleck retinopathy, malabsorption, nyctalopia, vitamin A deficiency, xerophthalmia

  • Vitamin A Deficiency Retinopathy Few Months Post Treatment With Resolution of the Retinopathy OS

    Nov 17 2019 by John S. King, MD

    45-year-old female with a history of gastric bypass surgery, who was referred to Dr. Zocchi for as a possible choroidal dystrophy; patient had severe nyctalopia that had progressed over a year; acuity was 20/20 OU with normal IOP and A/C findings. The posterior segment showed multiple yellow-white punctate dots in the mid-periphery and periphery (see photo). Findings were consistent with probable vitamin A deficiency. Patient was started on Vit A, and levels were found to be very low. Vitamin A levels in the serum were greatly reduced. Patient was started on Vit A weekly infusions and PO daily. A few months later the punctate spots had resolved (there are some drusen like deposits in far periphery) and her nyctalopia had reversed.

    Photographer: Brandon Peter

    Imaging device: Optos CA

    Condition/keywords: fleck retinopathy, malabsorption, nyctalopia, vitamin A deficiency, xerophthalmia

  • Vitamin A Deficiency Retinopathy Few Months Post Treatment With Resolution of the Retinopathy OD

    Nov 17 2019 by John S. King, MD

    45-year-old female with a history of gastric bypass surgery, who was referred to Dr. Zocchi for as a possible choroidal dystrophy; patient had severe nyctalopia that had progressed over a year; acuity was 20/20 OU with normal IOP and A/C findings. The posterior segment showed multiple yellow-white punctate dots in the mid-periphery and periphery (see photo). Findings were consistent with probable vitamin A deficiency. Vitamin A levels in the serum were greatly reduced. Patient was started on Vit A weekly infusions and PO daily. A few months later the punctate spots had resolved (there are some drusen like deposits in far periphery) and her nyctalopia had reversed.

    Photographer: Brandon Peter

    Imaging device: Optos CA

    Condition/keywords: fleck retinopathy, malabsorption, nyctalopia, vitamin A deficiency, xerophthalmia

  • Suprachoroidal Hemorrhage

    Nov 16 2019 by Sophia El Hamichi, MD

    Ultrasound of the right eye of 43-year-old male presenting with suprachoroidal hemorrhage, note the multilobulated heterogenous echogenic mass aspect of the choroid

    Photographer: Fiona J Ehlies, Murray Ocular Oncology and Retina, Miami

    Condition/keywords: B scan ultrasound, suprachoroidal hemorrhage

  • Neovascularization Elsewhere in Proliferative Diabetic Retinopathy

    Nov 16 2019 by Anfisa Ayalon

    Fundus autofluorescence image of neovascularization elsewhere, patient with high-risk proliferative diabetic retinopathy.

    Photographer: Anfisa Ayalon, Meir Medical Center, Kfar Saba, Israel.

    Condition/keywords: diabetes, fundus autofluorescence (FAF), ischemia, neovascularization elsewhere (NVE), proliferative diabetic retinopathy (PDR)

  • Toxoplasma Scar [Color Photo]

    Nov 15 2019 by Sham Talati

    Fundus photograph of toxo scar on macula.

    Photographer: Dr. Sham Talati,Retina Foundation,Ahmedabad

    Imaging device: Nidek Mirante

    Condition/keywords: toxoplasmosis, toxoplasmosis chorioretinitis

  • Toxoplasma Scar [Color Photo]

    Nov 15 2019 by Sham Talati

    Fundus photograph of toxo scar on macula.

    Photographer: Dr. Sham Talati,Retina Foundation,Ahmedabad

    Imaging device: Nidek Mirante

    Condition/keywords: toxoplasmosis, toxoplasmosis chorioretinitis

  • Toxoplasma Scar [Retro mode]

    Nov 15 2019 by Sham Talati

    Fundus photograph of toxo scar on macula.

    Photographer: Dr. Sham Talati,Retina Foundation,Ahmedabad

    Imaging device: Nidek Mirante

    Condition/keywords: toxoplasmosis, toxoplasmosis chorioretinitis

  • Toxoplasma Scar [Retro mode]

    Nov 15 2019 by Sham Talati

    Fundus photograph of toxo scar on macula.

    Photographer: Dr. Sham Talati,Retina Foundation,Ahmedabad

    Imaging device: Nidek Mirante

    Condition/keywords: toxoplasmosis, toxoplasmosis chorioretinitis

  • Toxoplasma Scar [Autofluorescence]

    Nov 15 2019 by Sham Talati

    Fundus photograph of toxo scar on macula.

    Photographer: Dr. Sham Talati,Retina Foundation,Ahmedabad

    Imaging device: Nidek Mirante

    Condition/keywords: toxoplasmosis, toxoplasmosis chorioretinitis

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