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JAMA Ophthalmology Clinical Challenge
April 2016

Retinal Rings

Author Affiliations
  • 1Department of Ophthalmology, University of Virginia, Charlottesville
  • 2Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
JAMA Ophthalmol. 2016;134(4):459-460. doi:10.1001/jamaophthalmol.2015.3646

A woman in her early 80s with a history of systemic hypertension and heart failure presented with retinal changes in both eyes. She denied any history of serious infections, including tuberculosis and syphilis, and denied having family members with visual difficulties. The patient had no visual complaints but stated that it was difficult for her to see at night. Her ocular history was remarkable only for bilateral cataract surgery by phacoemulsification many years prior. Visual acuity was 20/50 OU and pupillary responses, external examination, extraocular motility, and intraocular pressures were normal. Confrontation visual field testing showed peripheral constriction in each eye. Slitlamp examination showed the absence of anterior chamber inflammation and the presence of posterior chamber intraocular lenses and liquefied vitreous with a few vitreous strands bilaterally. Fundus examination (Figure, A) revealed poor foveal light reflexes, an annular pattern of outer retinal hypopigmentation approximating the border of the temporal arcades, and inferotemporal clumped pigment deposits in each eye. Spectral-domain optical coherence tomography (Figure, B) showed outer retinal foveoschisis as well as outer retinal thinning with interruptions in the ellipsoid in the peripheral macula in each eye. Fluorescein angiography showed no disc leakage or angiographic macular edema (Figure, C); there was faint staining of the annular area of hypopigmentation seen on fundus examination. Fundus autofluorescence showed a ring of abnormal hyperautofluorescence.

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