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April 16, 2020

Bilateral Enlargement of the Foveal Avascular Zone on Optical Coherence Tomography Angiography Associated With Cocaine Use

Author Affiliations
  • 1Carver College of Medicine, Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City
  • 2Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park
  • 3Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park
  • 4Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena
JAMA Ophthalmol. 2020;138(6):708-710. doi:10.1001/jamaophthalmol.2020.0919

Cocaine is a well-known cause of vascular injury and secondary end-organ damage. The presented case demonstrates retinal vascular abnormalities associated with a history of cocaine use in the absence of other retinal disease.

A 61-year-old Latino man was referred for evaluation of gradual worsening near visual acuity and an inability to find a satisfactory refraction. His best-corrected visual acuity was 20/30 in each eye. Optical coherence tomography demonstrated bilateral inner retinal atrophy with disruption of the inner retinal layers and effacement of the foveal contour (Figure 1). These changes spanned multiple vascular distributions. Fluorescein angiogram showed an enlarged foveal avascular zone without evidence of peripheral capillary nonperfusion (Figure 1). Optical coherence tomography angiography (OCTA) demonstrated an absence of perifoveal capillary flow, which resulted in an enlarged and irregular foveal avascular zone seen most prominently within the deep capillary plexuses (Figure 2). The areas of inner retinal atrophy corresponded to large flow voids seen within the retinal circulation (Figure 2). Humphrey visual field 10-2 demonstrated bilateral central scotomas, while a full-field electroretinogram was unremarkable.

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