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JAMA Ophthalmology Clinical Challenge
November 15, 2018

Central Scotoma After Liver Transplant

Author Affiliations
  • 1Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
JAMA Ophthalmol. Published online November 15, 2018. doi:10.1001/jamaophthalmol.2018.3564

A 54-year-old man with a medical history of poorly controlled diabetes and hepatitis C–associated liver failure presented with a new central scotoma of the right eye 3 days after orthotopic liver transplant. He denied eye pain, floaters, and photopsias.

The patient had his first liver transplant 12 years before presentation that failed despite immunosuppressive treatment with tacrolimus. He initiated mycophenolate mofetil treatment 2 months before his second transplant. In addition, the patient was positive for cytomegalovirus (CMV) IgG antibodies and had an undetectable CMV load 1 month before transplantation.