History
15 Year Old Boy
Fit and Well
No family history of anything
On Holiday in Cyprus 4 months ago noticed:
Sudden blur both eyes with white patches in centre of vision
Has got slightly better since then but still ‘not right’
Examination
OD VA 0.42 OS VA 0.52
See fundus and OCT pictures
On further questioning
Parents admit to possessing a laser pointer
Patient adamantly refutes all allegations of shining in own eyes
No family history of anything at all even vaguely eye related
Patient denies looking at sun while in Cyprus
Questions
1) Differential diagnoses?
2) Describe the fundus photograph findings
3) Describe the OCT findings
4) Most likely diagnosis
5) Prognosis and complications
Answers
1) DD: phototoxic maculopathy (i.e solar retinopathy); early stargardts disease; retinal pigment epithelitis and Mactel 2
2) B/L central foveal retinochoroidal pigmented scarring
3) OCT: ELM disruption- intact, outer retinal defect with RPE clumps in space and outer segment hyper reflectivity
4) Laser induced maculopathy
5) Prognosis - metamorphosis and scotoma, ERM, macular hole and CNV. Poor central vision.
British laser safety standards
DD: phototoxic maculopathy (i.e solar retinopathy); early stargardts disease; retinal pigment epithelitis and Mactel 2
B/L central foveal retinochoroidal pigmented scarring
OCT: ELM disruption- intact, outer retinal defect with RPE clumps in space and outer segment hyper reflectivity
Laser induced maculopathy
Prognosis - metamorphosis and scotoma, ERM, macular hole and CNV. Poor central vision.
Author: Safa El Hassan