Why some patients with Moderate non-neovascular ARMD presented with reduced vision?

When a patient with moderate Dry ARMD (age-related macular degeneration) complains of reduced vision, the main reason is ellipsoid zone disruption and RPE (retinal pigment epithelium) dysfunction. The upper OCT picture shows healthy RPE, Ellipsoid zone, and external limiting membrane, where the lower image shows RPE drusenoid detachments and disruption of the ellipsoid zone.

Check clinical guidelines for ARMD

#Retina #Macula #ARMD #Age #RPE #Ellipsoid #Dry #OCT #Moderate #Drusen

Normal OCT and OCT with soft drusen

Comments

Cellophane maculopathy

Caused by an epiretinal membrane, clinically, it appears as a sheen abnormal foveal reflex which features epiretinal membrane, due to inflammatory mediators and proliferation of glial cells secondary to a partial separation of posterior cortical vitreous. Fundus image shows cellophane maculopathy OCT features a hyperreflective band covering the inner retinal layers, causing minimal disturbance of inner retinal tissues. OCT cross-section shows epiretinal membrane Cellophane maculopathy itself in individuals with good visual acuity may not need any interventions, but it is warranted to do a detailed peripheral retinal exam to rule out retinal tear or hole However, an epiretinal membrane may proliferate further and cause additional tangential traction. Thus, it may induce macular pucker or lamellar/pseudo hole and increase disturbance of inner retinal tissues, macular thickness, and reduction of vision. These patients may require pars plana vitrectomy to remove the epiretinal membrane an

RPE tear, and it's OCT features in a nutshell

RPE tear can occur in vascularized PEDs due to a complication of intravitreal AntiVEGF treatment, which causes a rapid contraction of CNVm, inducing traction on the RPE surface and shrinking of RPE surface. On OCT, the RPE rip will indent the retina with increased hyperreflectivity in contracted RPE with underlying shadowing hinders choroidal view in contrast to the area where RPE where it ripped of which only Bruch's membrane is visible and increasing the visibility of the underlying choroid. RPE tear Thus two opposite forces, the regression of CNVm and remaining attached RPE, other causes such as laser or spontaneous can occur. However, the AntiVEGF treatment continued despite the RPE tear. Please check Clinical guidelines for ARMD and course of clinical changes in RPE

Diabetic macular edema with ischemic changes associated with very severe NPDR

A 51 years old male known to be diabetic for ten years with excellent glycemic control profile along with normal blood pressure presented with BCVA 20/100 in his left eye; he had a better vision of 20/30 in the same eye one year ago when he used to be on intravitreal injections of aflibercept, but he decided to discontinue intravitreal injection as been advised by another physician. Fundus image His fundus image shows cystic formation at the fovea with a sign of intraretinal dot and blots hemorrhages in the mid periphery with cotton wool spots and IRMA (Intra Retinal Microvascular Abnormalities). Fundus image showing macular edema with intraretinal hemorrhage and cotton wool spots Optical coherence tomography His OCT scan shows thickened central macular tissues with disorganization of inner retinal layers and non-empty cystic formation as it is classic findings of diabetic macular edema with some empty cystic formation; however, the ellipsoid zone looks intact. OCT cross-section for ce

Retinal Assistant Module Blog

Search This Blog