First Author: C.S.Ferreira PORTUGAL
Co Author(s): J. Pinheiro-Costa M.S. Falcão S. Penas T. Bragança E. Brandão Â. Carneiro 0 0 0 0 0 0 0 0 0
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To report a case with a difficult differential diagnosis: retinal changes conditioned hypovision in a monocular patient with multiple systemic comorbidities. The etiology remains undefined.
Study performed at Hospital São João, a tertiary health care center.
Retrospective and descriptive case report based on data from patient observation and analysis of diagnostic tests: optical coherence tomography (OCT), fluorescein angiography, indocyanine green angiography and serial ultrasounds.
A 71-year-old man, monocular (accident) referred for progressive hypovision. Background: Chronic hemodialysis (membranoproliferative glomerulonephritis), heart failure, autoimmune thrombocytopenia, deep vein thrombosis (hypocoagulated), intestinal polyposis and chronic atrophic gastritis with intestinal metaplasia, cholecystectomy, umbilical hernioplasty, diverticular disease, hypertension, dyslipidemia, and hyperuricemia. Ophthalmological examination: Visual acuity (VA) 6/10, nuclear cataract and fundus with elevation of posterior pole, abnormal distribution of pigment, optic disc edema and inferior exudative detachment. OCT – elevation of posterior pole from irregular thickening of the choroid . Fluorescein Angiography - hyperfluorescence on points with mottled appearance. Indocyanine green angiography - hyperfluorescence with irregular mottled hypofluorescent appearance, most evident in the posterior pole, occupying the entire space between the temporal retinal vascular arcades. Ultrasounds – decresing diffuse uveal thickening. The lesion is stable, VA 5/10 at last consultation.
The differential diagnosis of this lesion is complex. It includes isolated eye diseases or systemic diseases manifestations, particularly important in this case, given the multiple comorbidities presented. Choroidal hemorrhage is an example. It can also be an ocular manifestation of a tumor, which includes a bilateral diffuse uveal melanocyte proliferation, difficult to document in this patient, as he is monocular.