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JAMA Ophthalmology Clinical Challenge
April 30, 2020

Rapidly Progressive Bilateral Visual Acuity Loss in a Middle-Aged Woman

Author Affiliations
  • 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
JAMA Ophthalmol. 2020;138(6):706-707. doi:10.1001/jamaophthalmol.2020.0580

A 46-year-old healthy Hispanic woman presented with 2 days of photophobia in her right eye. Her best-corrected visual acuity (BCVA) was 20/30 + 2 OD and 20/20 OS. Her intraocular pressure, extraocular motility, and pupillary light reactions were normal. An examination demonstrated trace anterior cells in the right eye; otherwise, the examination had normal results. No vitreous cells were present. Topical prednisolone was started for presumed acute anterior uveitis.

One week later, the photophobia had improved. However, unnoticed by the patient, her BCVA had worsened to 20/200 OD and 20/40 OS. An examination demonstrated new subretinal fluid in the macula in the right eye (Figure 1A). Fluorescein angiography showed peripapillary speckled pinpoint areas of hyperfluorescence in the right eye. Indocyanine green showed early choroidal vessel hyperfluorescence and several posterior focal hypofluorescent spots in the midphase in both eyes. Autofluorescence showed patchy hyperautofluorescence in both eyes. Tuberculosis and syphilis testing had negative results. A complete blood cell count was unremarkable. A diagnosis of central serous retinopathy (CSR) was made. The topical prednisolone was stopped.

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