Case 10

A 30 years old male presenting with bilateral diminution of vision. He had a history of left ear infection 5 months ago for which he received medical treatment untill he had a cerebral vascular occlusion and an increase in his ICT (as described by the patient). He then had an ear surgery to relieve the problem 2 months ago and he has been well ever since except for his vision.
His BCVA is 3/60 OD and CF 80 cm OS.

Fundus photos show extensive retinal hemorrhage occupying the inferior fundus of both eyes, sheathed vessels in the same area (click on the image to enlarge), hard exudates in the inferior maculae, disc pallor more in the right with blurring of its edges.

What do the pictures show? Why the inferior fundus bilateral? What is the likely cause?

Case 9

A 45 years old male is presenting to do refractive surgery to get rid of his glasses. Ocular examination is normal. His glasses are Rt. sphere -5.25 cylinder -2.50X155, Lt. only cylinder -3.50X145. His BCVA is 0.5 bilateral. Corneal pachymetry and topography were done and his central corneal thickness in the right 495 microns and left 504 microns.

Corneal topography (normalized scale) shows asymmetrical vertical bowtie astigmatism with some inferior steepening. Keratoconus possibility index (KISA) is within normal (<60%> no Keratoconus), it is 4 for the right and 5 for the left.

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Does this patient have Keratoconus? Would LASIK procedure be an option for him? Does he need any other management?

Case 8

A 57 years old female presented with severe diminution of vision in the left eye which is constantly decreasing. She has a history of NIDDM of 5 years with poor control. BCVA was 3/60. She has already seeked ophthalmological advice and has received bilateral LASER treatments for her retina.

FFA was done and shows disc oedema with splinter hemorrhages, lower macular retinal oedema associated with other focal exudative changes, scattered microaneurysms and no evidence of retinal ischemia or vascular proliferation.

What is the likely diagnosis, further investigations and management?

Case 7

A 25 years old female complained of some diminution of vision in the left eye.
Examination of the posterior segement revealed an upper temporal macular lesion with overlying vitreous haemorrhage.
1st FFA and Ultrasound were done followed by OCT.

FFA report shows an eleveated lesion with SRF with no clear evidence of vessel involvement with overlying hemorrhage and no evidence of retinal mass.

Ultrasound report did not exclude a mass and showed the elevated lesion which was said to be either subretinal serous or hemorrhagic acculumation.

Finally OCT was done and to my surprise it did not show any serous detachment of the retina but a detachment of the ILM and part of NFL, there was total PVD and there was posterior shadowing in some parts by the overlying organized vitreous hemorrhage.

What is the likely diagnosis of this case?
Is there any more confirmatory investigations?
And finally how would it be managed?

Case 6

This case is presented by Rabab Khattab Msc.

Female patient 80 years old, diabetic since 20 years , bilateral pseudophakia, history of right old branch vein occlusion. PRP and intravitreal injection 4 months ago.
current presentation is diminution of vision. BCVA Rt. 5/60 Lt. 6/60.






What has interrested me is the picture of the background macula in the early phase of FFA seen as homogenous hyperfluorescent dots (enlarge the image to see it) showing late diffuse leakage and causing diffuse macular oedema which is confirmed by OCT.
Is this an ischemic macula or just diffuse excudative maculopathy? and how should it best be managed?

Case 5

A 45 years old male presents with sudden diminution of vision in the right eye 2 days ago, his BCVA is PLGP. He is hypertensive with no history of other systemic diseases.

The colour photo shows retinal pallor, cherry red spot at the fovea, and attenuated retinal arteries.

OCT line scan passing through the fovea shows an increase in overall retinal thickness and hyper-reflectivity of the inner retina with posterior shadowing.

What do you think is the diagnosis, any other investigations needed and what about the management?

Case 4

28 years old male with a past history of lumbar puncture and who presents with recent attacks of headache and blurring of vision. His BCVA is 6/12 bilateral. These are the colour photos of his fundus and the respective OCT line scans (vertical) passing through the optic nerve of the left then the right eye.

The images show pre-papillary white patches with minimal blurring of mainly the nasal disc edge, the OCTs show cup filling with elevation of the disc edges. What do you think?

Case 3

Color photography shows a red rounded lesion surrounded by hard exudates and hemorrhage located along one of the branches of the inferior temporal retinal artery.
FFA shows an early hyperfluorescent spot corresponding to the lesion seen in the color photo, which increases in intensity and slightly in size along the angiogram. Areas of blocked fluorescence correspond to the hemorrhage seen in the color photo.
OCT line scan passing through the hyperfluorescent spot seen in FFA shows markedly increased retinal thickness with intraretinal fluid accumulation (hemorrhage) causing underlying shadowing. There is also evidence of partial PVD.

Case 2

This case is presented by Consultant Dr. Azza Ismaiel:

The parents of a 7 year old child noticed facial asymmetry since birth. Seeking medical advice, the child was diagnosed as having left facial hypoplasia. U/S done at the age of 3 months gave the diagnosis of left PHPV (persistent hyperplastic primary vitreous). No intervention was done since then. Recently the parents came seeking ophthalmic advice aiming to achieve improvement of visual acuity in the left eye.

Color photo shows a well-defined whitish lesion in front of the disc with ghost vessels along the upper arcade. Another ill-defined whitish lesion was detected in front of the previously described one occupying the posterior vitreous compartment. The macular area could not be evaluated due to uncooperative patient.

U/S shows a lesion arrising from the optic disc that has a highly echogenic surface and heterogenous internal echogenicity.

U/S examination of the nasal retina showing moderately echogenic band extending from the retina to the ora serrata.

Case 1

A child complaining of diminution of vision.

Colour photo showing optic nerve lesion associated with macular detachment.

OCT line scan showing macular detachment

OCT line scan passing through the optic nerve showing a defect (red arrow).

Kindly add your comment about the diagnosis and if possible management!

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