A 75 years old male with reduced vision OS to counting fingers with a history of one intravitreal injection of aflibercept
Fundus image
The fundus image shows subretinal blood with druses and elevated retinal tissue.
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| Fundus image shows subretinal hemorrhage |
Optical coherence tomography
OCT scan shows the following
the red arrows show both pigment epithelium detachment (PED) and visible Bruch's membrane, a double layer sign with dilated Haller's and thickened choroid that indicates a pachychoroid.
In this case, PED with heterogenous content, while the blue star shows subretinal hemorrhage, but the blue arrow shows subretinal fluid. Another finding in this OCT scan is the disturbed ellipsoid zone with no intraretinal fluids.
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| OCT cross-section showing PED with subretinal hemorrhage |
Discussion
The Differential diagnosis here is occult neovascular ARMD or polypoidal chorioretinopathy.
This case is best managed with intravitreal injection of AntiVEGF. In cases of treatment failure, pneumatic displacement is considered with or without intravitreal tPA.
Please drop a comment below on how you would handle this case??.
Please check Clinical guidelines for ARMD
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ReplyDeleteQuesto è un case report molto informativo e ben presentato. La spiegazione dei reperti del fondo oculare e delle caratteristiche OCT facilita la comprensione del quadro clinico, in particolare i dettagli relativi al distacco dell'epitelio pigmentato retinico (PED), all'emorragia sottoretinica e alle caratteristiche della pachicoroide. Anche la discussione sulle possibili diagnosi, come la degenerazione maculare senile neovascolare occulta e la corioretinopatia polipoide, è molto utile per i lettori interessati all'oftalmologia. Grazie per aver condiviso un'analisi clinica così preziosa! altadefinizione horror streaming ita
ReplyDeleteQuesta presentazione del caso è molto informativa e ben documentata. Il modo in cui hai correlato i risultati del fundus con le caratteristiche dell'OCT come il distacco dell'epitelio pigmentato retinico (PED), le alterazioni della pachicoroide e l'emorragia sottoretinica è davvero utile per comprendere il quadro clinico. Viene inoltre chiaramente spiegata la differenza tra degenerazione maculare senile neovascolare occulta e corioretinopatia polipoide. La gestione con anti-VEGF e le alternative come lo spostamento pneumatico aggiungono un grande valore pratico per i lettori. Dopo aver esaminato casi medici così dettagliati, è piacevole fare una pausa con un po' di streaming community film gratis alta definizione.
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