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Dorchester Center, MA 02124

Acute Exudative Polymorphous Vitelliform Maculopathy


History of Present Illness (HPI)

A 61-year-old woman with a remote history of laser-assisted in situ keratomileusis (LASIK) both eyes (OU) is referred to you for evaluation of posterior uveitis. She noticed a “grayish smudge” in the center, OU, starting about 2 months ago. She saw an outside ophthalmologist, who noted posterior pole lesions, started prednisolone acetate eye drops four times a day (QID), ordered basic laboratory work, and then sent her to you. She has already had a QuantiFERON, fluorescent treponemal antibody absorption (FTA-ABS), rapid plasma reagin (RPR), angiotensin-converting enzyme (ACE), lysozyme, chest x-ray, antinuclear antibodies (ANA), antineutrophil cytoplasmic antibodies (ANCA), Lyme serologies, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), complete blood count (CBC), basic metabolic panel (BMP), and urinalysis, all of which were normal.

Her symptoms have been approximately stable since onset. She denies flashes or floaters. She is extremely anxious about her condition and is worried she will go blind.

Past Medical History

  • Coronary artery disease

  • Hypertension

  • Hypercholesterolemia

    Fig. 56.1, (A) Color fundus photograph of the right eye shows a large, yellow-orange, placoid-like lesion deep to the temporal macula with several smaller, circular satellite lesions. (B) Color fundus photograph of the left eye shows remarkably similar lesions to the right eye.

Exam
OD OS
Vision 20/30− 20/30
Intraocular pressure (IOP) 16 14
Lids and lashes: Normal Normal
Sclera/conjunctiva: White and quiet White and quiet
Cornea: Clear Clear
Anterior chamber (AC): Deep and quiet Deep and quiet
Iris: Flat Flat
Lens: Trace nuclear sclerosis (NS) Trace NS
Anterior vitreous: Clear Clear
Dilated fundus examination (DFE): Fig. 56.1A Fig. 56.1B

Further Questions to Ask

  • Do you have any history of cancer?

  • Have you felt unwell recently? Any fevers, chills, myalgias, headache, or upper respiratory symptoms?

She has no history of cancer. She had a mild viral illness about 3 months ago but nothing out of the ordinary.

Because the diagnosis was still unclear after examination, optical coherence tomography (OCT) and fluorescein angiography (FA) were pursued ( Figs. 56.2 to 56.4 ).

Fig. 56.2, (A) OCT of the right macula shows subretinal fluid with hyperreflective material adjacent to the outer retina. (B) OCT of the left macula shows very similar findings.

Fig. 56.3, (A) Early frame FA of the right eye shows blocking of fluorescence by subretinal material. (B) Late frame of the FA, right eye. There is no leakage or vascular inflammation.

Fig. 56.4, (A) Early frame FA of the left eye shows blocking of fluorescence by subretinal material. (B) Late frame of the FA, left eye. There is no leakage or vascular inflammation.

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