Presenters: Elon van Dijk (THE NETHERLANDS)
Fundoscopy of the left eye revealed no abnormalities, except for a preretinal vitreous opacity. Fundoscopy of the right eye showed vitreous cells. In the macula a yellowish discoloration was present
A 45 year old woman was referred to our emergency clinic. She had complaints of seeing a dark fleck in the center of the visual field of the right eye since 1,5 weeks. She had never had similar complaints, and her general medical history was unremarkable. She had no systemic complaints.
The visual acuity in the right eye was 0.2 Snellen equivalent, whereas this was 1.5 Snellen equivalent in the left eye. On slit-lamp examination, 1+ cells were present in the anterior chamber of the right eye.
Fundoscopy of the left eye revealed no abnormalities, except for a preretinal vitreous opacity. Fundoscopy of the right eye showed vitreous cells. In the macula a yellowish discoloration was present, whereas multifocal lobular white/yellowish subretinal lesions, mostly in the nasal and inferior fundus, were seen in the periphery. Some lesions inferiorly showed hyperpigmented spots and beginning atrophy.
To further discern between several diseases in the differential diagnosis, one of the first additional examinations that we performed was obviously an OCT scan. OCT scanning showed quite an impressive picture in the right eye: a hyperreflective accumulation between the neuroretina and the RPE, while the RPE showed a confluent detachment with moderate to low hyperreflective abnormalities beneath it. The scan of the lesions in the inferior region showed marked RPE detachments, with hyperreflective accumulation beneath it.
What’s the (differential) diagnosis? And what do we have to do to prove this?