Grand Rounds - What would you do?

[Richard_Hom]

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Dear pre-doctoral 3th, 4th, residents and newer graduates:

HPI:
A 70+ year old male presents from the ED for a 5 month history of sudden
loss of vision He reports no pain or trauma. He did complain of intense
itching about the same time. He is on no eye medications.

Historically, the patient had an initial ECCE with IOL this eye. 2
subsequent procedures later, the patient's PCIOL was removed and the iris
was significantly diminished. At 7 days after the last procedure, his vision
was satisfactory. Shortly thereafter, his vision decreased dramatically.

His general medical history is unrelated. The patient's fellow eye is NLP
following a cataract extraction done several years previously.

PE:
Best vision is OD NLP and OS HM at 2 ft with poor directionalization.
Aniridia, OS
Aphakia, OS
T/app is 8mm Hg.
AC in OS is quiet and clear
Vitreous clear
Retina - see photo (if not attached, I'll be glad to send)

Diff Dx?
Additional tests?
Management?

Regards,
Richard Hom, OD,FAAO
San Mateo, CA

 

[ituryu]

Well I am going to try and put in some thing here . First question you asked was differential dx , I would rather give a tentative dx , & say it's a retinopathy ie , an atrophised retina probably due to vascular occlussion , I think I would study this first and get back here to reply . 😕

 

[Andrew_Doan]

Diff Dx?
Additional tests?
Management?

Looks like PVR or retinal detachment. I'd send to a retina specialist for evaluation and treatment.

 

[optcom]

The view under the membrane-like structure is hazy, it looks likely RD. Is macula involved? Edema? love to have more info on this patient.