Sherrol Reynolds

Peripapillary vitreoretinal traction.

BACKGROUND Vitreoretinal traction syndrome may occur in patients with incomplete posterior vitreous detachment. Although vitreoretinal traction of the macula is well-documented in the literature, the manifestations of peripapillary vitreoretinal traction are rarely discussed. CASE REPORT A 62-year-old black woman presented for a comprehensive examination. She reported having uncontrolled diabetes and hypertension. Best-corrected visual acuities were 20/30 in the right eye (OD) and 20/25 in the left eye (OS). Dilated examination found a flame-shaped hemorrhage OD. The optic nerve margins OS were blurred, with the margins appearing elevated with peripapillary intraretinal hemorrhages. Cirrus spectral domain optical coherence tomography (OCT) found the presence of peripapillary vitreoretinal traction with concurrent vitreomacular traction OS. CONCLUSION Although the effects of vitreoretinal traction are most commonly associated with the macula or peripheral retina, residual attachment can occur at the optic nerve head. Peripapillary vitreoretinal traction can cause optic nerve head elevation with the appearance of edema that must be distinguished from sight- or health-threatening etiologies. OCT is a valuable diagnostic tool in confirming peripapillary vitreoretinal traction.

Complex juxtapapillary capillary hemangioma: A case report

BACKGROUND Juxtapapillary capillary hemangiomas can occur as isolated clinical abnormalities or a manifestation of von Hippel-Lindau (VHL) disease. Because of the location of these vascular tumors on or adjacent to the optic disc, any therapeutic treatment option involves risk. Management typically includes close monitoring, with treatment initiation as the tumor progresses or when vision is compromised. This case report reviews this condition while highlighting the treatment and potential complications associated with juxtapapillary capillary hemangioma. CASE REPORT A 14-year-old black male had juxtapapillary capillary hemangioma diagnosed during a routine eye examination. The patient complained of blurry vision in the right eye, and best-corrected visual acuities (BCVA) were 20/25 O.D. and 20/20 in the left eye. At the retinologists discretion, no treatment was initiated, and the patient was advised to return in 4 months for a dilated retinal evaluation and referred for magnetic resonance imaging (MRI) with contrast of the brain. The patient was lost to follow-up and presented a year later when vision had deteriorated to 20/400 O.D. with an associated afferent pupillary defect. Enlargement of the juxtapapillary capillary hemangioma with increased fibrovascular growth, macular exudation, and subretinal fluid was observed O.D. Photodynamic therapy was initiated, and the patient experienced treatment complications, including a vitreous hemorrhage and serous retinal detachment. A scleral buckling procedure, vitreoretinal surgery, and endo-laser photocoagulation were performed. The patients visual acuity improved from 20/400 to 20/60 O.D., with the development of a dense posterior subcapsular cataract, for which the patient had cataract extraction. Genetic testing was positive for a small deletion in codon 76 of the von Hippel-Lindau gene, and MRI of the brain was reported to be normal. Additional testing to rule out visceral organ involvement, including abdominal ultrasound scan, urinalysis, and blood chemistry were ordered, and the patients family was also evaluated for the presence of the VHL gene. CONCLUSION The clinical course of juxtapapillary capillary hemangiomas is highly variable, potentially leading to significant ocular complications. Currently, no definitive treatment guideline is available, and any therapeutic option involves inherent risk because of the location of these tumors. Because juxtapapillary capillary hemangioma may be the only manifestation of VHL disease, genetic and clinical screening of patients and their relatives is highly recommended. Early diagnosis and treatment may improve both the visual and systemic prognosis in patients with juxtapapillary capillary hemangiomas.

A deeper look at torpedo maculopathy: A deeper look at torpedo maculopathy Hamm, Shechtman and Reynolds

Background Torpedo maculopathy is a rare, congenital maculopathy classically diagnosed funduscopically as a ‘torpedo-shaped’ lesion located temporal to the fovea. This case describes a torpedo maculopathy with non-classic optical coherence tomographic (OCT) findings and collaborative OCT angiographic (OCTA) findings. Case report A 60-year-old Caucasian woman presented with a history of longstanding distortion and paracentral scotoma of the right eye. She had a positive family history of age-related macular degeneration. Visual acuity was 6/6 in each eye. Dilated fundus examination revealed a torpedo-shaped lesion in the right eye with a hypo-pigmented head pointing toward the fovea and a hyper-pigmented tail end. OCT imaging of the macula of the right eye revealed a subretinal cleft space with underlying thinning of the retinal pigment epithelium, increased choroidal reflectivity, as well as retinal pigment epithelial and choroidal excavation. OCTA choriocapillaris segmentation showed a hypo-reflective area associated with the lesion, adjacent to hyper-reflectivity. The patient was diagnosed with torpedo maculopathy of the right eye. Conclusions OCT and OCTA imaging have been instrumental in developing a deeper understanding of many maculopathies, allowing for accurate diagnosis of macular conditions. Although the aetiology remains unclear, these imaging devices may provide further insight into the lesion in torpedo maculopathy.Torpedo maculopathy is a rare, congenital maculopathy classically diagnosed funduscopically as a ‘torpedo‐shaped’ lesion located temporal to the fovea. This case describes a torpedo maculopathy with non‐classic optical coherence tomographic (OCT) findings and collaborative OCT angiographic (OCTA) findings.

A deeper look at torpedo maculopathy

Background Torpedo maculopathy is a rare, congenital maculopathy classically diagnosed funduscopically as a ‘torpedo-shaped’ lesion located temporal to the fovea. This case describes a torpedo maculopathy with non-classic optical coherence tomographic (OCT) findings and collaborative OCT angiographic (OCTA) findings. Case report A 60-year-old Caucasian woman presented with a history of longstanding distortion and paracentral scotoma of the right eye. She had a positive family history of age-related macular degeneration. Visual acuity was 6/6 in each eye. Dilated fundus examination revealed a torpedo-shaped lesion in the right eye with a hypo-pigmented head pointing toward the fovea and a hyper-pigmented tail end. OCT imaging of the macula of the right eye revealed a subretinal cleft space with underlying thinning of the retinal pigment epithelium, increased choroidal reflectivity, as well as retinal pigment epithelial and choroidal excavation. OCTA choriocapillaris segmentation showed a hypo-reflective area associated with the lesion, adjacent to hyper-reflectivity. The patient was diagnosed with torpedo maculopathy of the right eye. Conclusions OCT and OCTA imaging have been instrumental in developing a deeper understanding of many maculopathies, allowing for accurate diagnosis of macular conditions. Although the aetiology remains unclear, these imaging devices may provide further insight into the lesion in torpedo maculopathy.Torpedo maculopathy is a rare, congenital maculopathy classically diagnosed funduscopically as a ‘torpedo‐shaped’ lesion located temporal to the fovea. This case describes a torpedo maculopathy with non‐classic optical coherence tomographic (OCT) findings and collaborative OCT angiographic (OCTA) findings.