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JAMA Ophthalmology Clinical Challenge
April 2016

Angiographically Silent Macular Edema

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, University of Louisville School of Medicine, Louisville, Kentucky
  • 2Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky
JAMA Ophthalmol. 2016;134(4):453-454. doi:10.1001/jamaophthalmol.2015.3614

A man in his late 70s presented with a 1-month history of blurry vision in his left eye. He reported fatigue, muscle stiffness, joint pain, and a 10-lb unintentional weight loss. On ocular examination, his best-corrected visual acuity was 20/25 OD and 20/60 OS. Anterior segment examination findings were unremarkable.

Fundus examination revealed bilateral microaneurysms and dot hemorrhages throughout the posterior pole, along with bilateral macular edema and serous neurosensory detachment in the left eye (Figure 1A). Optical coherence tomography of the right eye revealed severe cystoid macular edema, and fluorescein angiography showed normal filling with multiple microaneurysms. An optical coherence tomographic image of the left eye showed a large neurosensory detachment with overlying and surrounding cystoid macular edema. Fluorescein angiography of the left eye demonstrated hypofluorescence without pooling or leakage of fluorescein dye over the area of neurosensory detachment, which was persistent in later frames (Figure 1B).

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