NEWS & EVENTS
Retinal Review, Issue 23
CASE NUMBER 23
A 94 year old man was referred for retinal hemorrhaging in both eyes. Past medical history is surprisingly normal. He is the self proclaimed “oldest living World War II veteran” and “healthiest World War II veteran”. He also has a 94 year old wife who is “the healthiest 94 year old married to a World War II veteran”. He noted mild photopsias over the past few weeks but no vision loss. On examination VA was 20/20- OU. IOP’s were normal. The SLE was only significant for clear PCIOL’s in both eyes. Dilated examination is noted below as well as fluorescein angiography:
The patient had bilateral peripapillary exudation and subretinal hemorrhages. The optic nerves themselves were normal and were without sign of edema or atrophy. The diagnosis in this case is bilateral exudative AMD with peripapillary CNVM’s. Most patients with exudative AMD require treatment. Treatment options include antiVEGF injections, thermal laser, and photodynamic therapy. If the CNVM is far enough away from the macula however, treatment can occasionally be avoided. Sometimes these CNVM’s can involute on their own. We advised a course of careful observation. The patient said he will continue to only eat organic nonprocessed foods and will maintain his strict exercise regimen.
He returned one month later with stable vision. Acuity remained 20/20- in both eyes. Dilated examination revealed a significant improvement in his retinal status:
Most of the subretinal hemorrhage and exudation had resolved. Macular drusen and atrophy were present in both eyes. He was left with peripapillary fibrotic scars. These scars usually remain stable and rarely reactivate. He was advised to return for follow up in three months and continue whatever he was doing to be the “healthiest 94 year old World War II veteran around”.