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JAMA Ophthalmology Clinical Challenge
May 2018

Cataract, Vitritis, and Diffuse Hypofluorescent Retinal Dots on Fluorescein Angiography

Author Affiliations
  • 1University of Minnesota, Department of Ophthalmology and Visual Neurosciences, Minneapolis
JAMA Ophthalmol. 2018;136(5):581-582. doi:10.1001/jamaophthalmol.2017.4426

A man in his early 30s with a 2-year history of chronic conjunctivitis and blurry vision in the left eye since his cornea was scratched by “a piece of wood” presented with progressive dull pain and decreased visual acuity in the left eye. Visual acuity was 20/400 in the left eye, improved to 20/100 with pinhole. Slitlamp examination revealed a small, nasal corneal scar, a small iris defect, iris heterochromia, and a cataract with overlying pigment (Figure 1A). Dilated funduscopic examination of the left eye demonstrated vitritis and a hazy view of the retina due to the opacity of the media. A color fundus photograph of the eye showed opacity of the media secondary to the cataract and vitritis and a slightly pale optic nerve. Fluorescein angiography (Figure 1B) demonstrated early hyperfluorescence of an inferotemporal chorioretinal lesion that increased slightly during the course of the study, consistent with possible leakage. There were multiple hypofluorescent dots throughout the retina and an appearance of segmentation of the vessels with slightly decreased venous filling and late staining. A computed tomography scan of the eye and orbit revealed a hyperdense foreign body located along the inferior aspect of the vitreous, approximately at the 5 o'clock position, abutting the retinal surface. Ultrasonography B scan revealed a highly reflective material causing posterior shadowing at the 5 o’clock position.

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