First Author: J.Afonso PORTUGAL
Co Author(s): C. Ângela B. Elisete F.R. Fernando 0 0 0 0 0 0 0 0 0
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To describe the clinical and multimodal imaging findings of one patient with multiple macular Retinal Pigment Epithelium (RPE) detachments.
Ophthalmology Department, Centro Hospitalar de São João, Porto, Portugal.
A case report of a 50 years old Caucasian women that is admitted to the general ophthalmology consultation with complains of presbyopia. The patient was systemically and ophthalmologically healthy. The only regularly prescribed medication were contraceptional pills. The patient had no ophthalmological symptoms and excluding fundus examination she had a normal ophthalmologic exam for her age including a 10/10 (Snellen scale) far sight visual acuity without correction and Jager score of 1.0 with a +2.00 D correction. On the fundus ophthalmoscopy the patient manifested multiple round lesions on the macular area of variable dimensions that were elevated and in the depth in reference to retinal vessels. In order to study this alterations an ophthalmological study was performed including color fundus photography, fundus autofluorescence imaging, fluorescein angiography, Indocyanine Green Chorioangiography (ICG) and Spectral-Domain Optical Coherence Tomography (SD-OCT). A systemic study is also in course. Unto this moment there is no leading cause found for the described alterations and regular follow-ups have been decided.
max 200 words The patient manifested multiple round lesions on the macular area of variable dimensions that were elevated and in depth in reference to retinal vessels on the colour fundus photography. The latter were hyper-autofluorescent and well circumscribed on fundus autofluorescence images. Fluorescein angiography findings included lesions with hyperfluorescence in the initial phase that displayed a fluorescein filling during to whole exam, and on the ICG they remained hypofluorescent during the whole exam. These lesions correspond to a dome of retinal pigment epithelia detachment of a mainly serous quality as seen in the SD-OCT although some had a hyperreflexive content that may correspond to drusenoid RPE detachments. Choroid findings studied with SD-OCT Enhanced Depth Imaging (EDI) technique found normal choroidal morphology and thickness with a mean of 257 µm on the right eye and 280 µm on the left eye (the vertical distance was measured with a horizontal scan centered on the fovea). In the 10 months follow up we observed some enlargement and discrete coalescence of lesions in both eyes. The systemic study that has been performed hasn’t found any leading cause for the described alterations until the moment.
With only few cases described in literature we describe a very rare condition, which has no cause that explains the described lesions until the moment, and which therefore may be considered idiopathic. This case report shows that EPR detachments may not directly be associated with symptoms or visual impairments and can be merely an imaging finding. Even though, follow up is needed due to the potential visual impairment and neovascular development.