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JAMA Ophthalmology Clinical Challenge
November 2018

Macular Vitelliform-Like Lesion in an Eye With Chronic Retinal Detachment

Author Affiliations
  • 1Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago
  • 2Associate Deputy Editor, JAMA Ophthalmology
JAMA Ophthalmol. 2018;136(11):1303-1304. doi:10.1001/jamaophthalmol.2018.1379

A 41-year-old woman with a history of ocular hypertension (and using brimonidine tartrate and timolol maleate) was referred by her ophthalmologist for a second opinion regarding yellowish subfoveal precipitates in her left eye. Three months earlier, she had undergone pneumatic retinopexy for macula-on retinal detachment (RD) with a superotemporal tear, followed by vitrectomy with gas injection for macula-on inferonasal detachment 1 month later. She had persistent postoperative subretinal fluid inferonasally, and she was concerned about a central scotoma. An examination within 2 months of the vitrectomy revealed yellowish subfoveal precipitates. Her best-corrected visual acuity was 20/20 OD and 20/200 OS. Extraocular motility was full, but she displayed left exotropia. Confrontational visual fields were full for the right eye but showed a decreased field inferiorly for the left eye. Intraocular pressures as determined using Tonopen tonometry were 13 mm Hg OD and 12 mm Hg OS. A slitlamp examination revealed trace nuclear sclerosis and pigmented cells in the anterior vitreous of the left eye. An ophthalmoscopic examination indicated laser and cryotherapy scars 360° around a horseshoe tear superotemporally in the left eye, whereas the right eye appeared normal. In addition, pre-equatorial subretinal fluid in the left eye between the 6-o’clock and 8:30 position was associated with 2 tiny holes at the 7:30 position and with a small area of fibrotic tissue contraction consistent with early proliferative vitreoretinopathy. The macula had yellow-white, flat, vitelliform-like lesions with a surrounding high watermark (Figure). No cyst, exudate, or hemorrhage was detected in the macula.

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