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JAMA Ophthalmology Clinical Challenge
August 15, 2019

An 81-Year-Old Man With Multifocal Choroidal Lesions

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois
JAMA Ophthalmol. Published online August 15, 2019. doi:10.1001/jamaophthalmol.2019.3054

An 81-year-old Mexican man was evaluated in the retina clinic for scattered subretinal lesions in the right eye. He complained of a gradual decline in his vision bilaterally over the past 2 years. He denied flashes, floaters, or eye pain but endorsed a chronic cough. He had no known ocular or medical history and took no systemic medications. He was born and raised in Mexico prior to his immigration to the United States 5 years before presentation. He worked as a farmer and denied recent illnesses, contacts with illnesses, alcohol or tobacco use, and having pets. His visual acuity was 20/60 OD and 20/40 OS with normal intraocular pressures. His slitlamp examination results were notable for mild nuclear sclerosis in both eyes and were negative for conjunctival or corneal lesions. He had round, reactive pupils and no anterior chamber inflammation in either eye. Dilated fundus examination results revealed a few pigmented anterior vitreous cells, a normal optic disc, and flat and large yellowish chorioretinal lesions with overlying pigment scattered throughout the macula and periphery in the right eye (Figure). The left eye had several similar chorioretinal lesions in the superotemporal periphery.

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