Poster 51

Poster 51

Poster Presentations was ordered for the treatment of the retinal angiomatous proliferation. Conclusion: Retinal angiomatous proliferation represents ...

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Poster Presentations was ordered for the treatment of the retinal angiomatous proliferation. Conclusion: Retinal angiomatous proliferation represents a clinically distinct subset of choroidal neovascularization in age-related macular degeneration. Prompt recognition and diagnostic staging facilitate treatment. This poster reviews the pathogenesis, staging, and clinical findings of retinal angiomatous proliferation. Moreover, the efficacy of various age-related macular degeneration treatment modalities for retinal angiomatous proliferation are examined. Poster 51 Bilateral Optic Nerve Atrophy Presenting With a Pituitary Adenoma David Sabin, O.D., Malcom Randall, VAMC, 1601 S.W. Archer Road, Eye Clinic 1st Floor, Gainesville, Florida 32608 Background: Pituitary adenomas are the most common intracranial tumors. Systemically they cause hormonal changes, and visually lead to field loss. Nonhormone-secreting tumors compress nearby structures causing decreased vision, color vision defects, diplopia, and visual field defects. Hormone-secreting tumors cause a variety of increased hormone production abnormalities leading to atypical hormone release. Diagnosis is assisted with visual field testing, biopsy, CT, MRI, or blood and urine test. Treatment options consist of observation, surgical removal of tumor, radiation therapy, or medication. Once treatment is initiated, systemic and visual symptoms may partially or completely resolve. Case Report: A 67-year-old white male presented for an HVF due to large C/D ratios and pale nerves noted on a prior visit. He denied any vision problems. His medical history was positive for anemia and larynx cancer for which he had received radiation therapy. The patient’s best-corrected visual acuity was 20/70 in the right eye and 20/40 in the left eye with no improvement with pinhole. Pupil examination revealed a positive APD in the right eye. EOMs and anterior segment examinations were unremarkable. His IOPs were 21 mmHg in both eyes. Fundus exam revealed C/D ratios of 0.75 in the right eye and 0.8 in the left eye. The optic nerve heads were distinct with diffuse pallor in both eyes. Review of lab testing was remarkable for a reduced vitamin B12 level of 208. Other lab testing including RPR, ANA, CRP, ESR, and folate were normal. The HVF revealed an absolute heteronomous hemianopsia with absolute inferior altitudinal defect in the right eye. MRI and neurology consultations were requested, and brimonidine therapy was initiated. The MRI confirmed a pituitary adenoma. The patient underwent a transphenoidal resection without radiation due to patient’s prior hypersensitivity to radiation. Conclusion: A pituitary adenoma compressing the optic nerve causing bitemporal visual field loss in both eyes and reduced vision in 1 eye went unnoticed in our patient. Optic

291 nerve pallor out of proportion to cupping may be a clue to compressive lesion. Due to the high frequency of pituitary adenomas, it is important for a clinician to recognize the signs and symptoms. Poster 52 A Case of Commotio Retinae Leading to Clinically Significant Macular Edema in a Diabetic Patient Tracy Kwan, B.S., and Stanley Woo, O.D., M.S., University of Houston, College of Optometry, 505 J. Davis Armistead Building, Houston, Texas 77204 Background: Blunt trauma to the eye may result in retinal edema also known as commotio retinae. Typically, no treatment is indicated because the condition is self-resolving. However, in vasculopathic patients such as diabetics at risk for clinically significant macular edema (CSME), it is unclear what intervention might be most appropriate. This case addresses the question of whether commotio retinae might trigger CSME in a patient with non-proliferative diabetic retinopathy (NPDR). Case Report: A 56-year-old Hispanic male was referred to the University Eye Institute after being hit in the right eye with a bungee cord. Past medical history included type 2 diabetes mellitus 1 year prior and poor medication compliance without any reported decrease in visual acuity. Bestcorrected visual acuity was 20/40- O.D. and 20/20 O.S. Macular swelling in the right eye was seen with OCT with an average foveal thickness of 281 ⫾ 53 microns. A dilated fundus exam revealed scattered dot blot hemorrhages O.S. and trace exudates O.D. The initial assessment was commotio retinae O.D. and NPDR. Two weeks later, the patient’s BCVA was 20/80⫹ O.D. Increased exudates and macular edema were seen O.D. along with a cotton-wool spot (CWS) superior to the nerve. HVFA Sita Std 10-2 showed minor central field defect O.D. OCT showed increased macular edema with an average foveal thickness of 380 ⫾ 66 microns. The assessment at that time was commotio retinae leading to CSME, and the patient was referred for focal grid laser. Three months following the laser surgery, the patient had a BCVA of 20/40 O.D. and decreased foveal thickness of 171 ⫾ 7 microns. Conclusions: The natural progression of this case suggests that more aggressive treatment including focal grid laser may be appropriate in the case of an uncontrolled diabetic patient with commotio retinae. The blunt force trauma may be sufficient to disturb the compromised anatomy and physiology of the vasculopathic retina resulting in a more guarded prognosis than with commotio retinae alone.