Clinical Cases in Medical Retina: A Diagnostic Approach

 

Medical retina is a complex subspecialty with a steep learning curve, requiring vast and diverse knowledge in basic science, diagnostic imaging, medical treatment, and surgical techniques. Clinical Cases in Medical Retina: A Diagnostic Approach provides highly visual, case-based guidance on the challenging process of gathering patient information, ordering appropriate testing, and arriving at an accurate diagnosis and effective treatment plan. In one convenient volume, it exposes retina fellows and specialists, ophthalmology residents, and other eye care clinicians to a wide variety of patient presentations and scenarios, including rare conditions and special populations.

 

Table of Contents:

 

Section 1. Hereditary Macular Conditions

1.  Yellow macular spots in a child

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 1.1: Algorithm for differential diagnosis for best disease

Key points

References

2.  Long-standing photophobia, reduced visual acuity, myopia, and dyschromatopsia in a young adult male patient

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 2.1: Algorithm for differential diagnosis for BED/BCM/X-linked cone dystrophy

Key points

References

3.  Bilateral progressive severe loss of vision and obesity

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 3.1: Algorithm showing differential diagnosis for retinopathy

Key points

References

4.  Bilateral peripheral retinal and macular schisis in a young boy

History of present illness

Questions to ask

Assessment

Differential diagnosis

Workup and diagnosis

Multimodal testing and results

Management

Follow-up care

Key points

Algorithm 4.1: Diagnostic flow chart X-linked retinoschisis (XLR)

References

5.  Congenital blindness and retinopathy in a young girl

History of present illness

Questions to ask to aid diagnosis

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 5.1: Algorithm for differential diagnosis of congenital blindness and retinopathy

Key points

References

6.  Progressive nyctalopia and tunnel vision in a young man

History of present illness

Questions to ask to aid diagnosis

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Surgical procedure for subretinal gene therapy

Algorithm 6.1 Algorithm of various inherited conditions causing nyctalopia with poor visual acuity in children

Key points

References

7.  Rapid progression of vision loss in a child with pigmentary retinopathy

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Investigations

Follow-up care

Management

Follow-up care

Key points

Algorithm 7.1: Algorithm for differential diagnosis of a child with pigmentary retinopathy and progressive vision loss

References

8.  Unilateral tractional retinal detachment in a 6-month-old female infant with erythematous skin lesions

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 8.1: Algorithm for differential diagnosis for retinal nonperfusion in infants

Key points

References

9.  Bilateral peripheral pigmentary changes in a woman

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 9.1: Algorithm for bilateral peripheral pigmentary changes

Key points

References

10.  I was never good at ghosts in the graveyard

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Genetic testing

Multimodal testing and results

Diagnosis

Enhanced S-cone syndrome

Management

Follow-up care

Algorithm 10.1: Algorithm showing diagnosis for enhanced s-cone syndrome

Key points

References

11.  Bilateral perifoveal degeneration in a woman

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 11.1: Algorithm for differential diagnosis for bilateral perifoveal degeneration

Key points

References

12.  Autosomal dominant radial drusen

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 12.1: Basic algorithm for macular dystrophies

Key points

References

Section 2. Degenerative/Deficiency

13.  Bilateral asymptomatic pigmentary retinopathy

History of present illness

Questions to ask

Assessment

Differential diagnosis1

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 13.1: Algorithm for the differential diagnosis of pigmented paravenous retinochoroidal atrophy

Key points

References

14.  Unilateral macular schisis with blurred vision in a woman

History of present illness

Questions to ask

Assessment

Differential diagnosis1

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 14.1: Algorithm representing myopic macular schisis

Key points

References

15.  Acute vision loss in an elderly patient associated with unilateral intraretinal blot hemorrhage in the macula

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal imaging

Management

Follow-up care

Algorithm 15.1: Algorithm for differential diagnosis of unilateral intraretinal macular blot hemorrhage with cystoid macular edema

Key points

References

16.  Bilateral macular and peripheral drusen in a young man

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 16.1: Algorithm for differential diagnosis of yellowish macular deposits/lesions

Key points

References

17.  Long-standing macular scars

History of present illness

Questions to ask

Assessment

Differential diagnosis and associated confirmatory tests

Working diagnosis

Multimodal testing and results

Management

Clinical pearls

Recognize the grades of NCMD

Algorithm 17.1: Algorithm showing steps involved in diagnosing and managing north carolina macular dystrophy

Acknowledgements

Key points

References

18.  Bilateral presentation of bull’s eye maculopathy

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 18.1: Algorithm for differential diagnosis for bull’s eye maculopathy

Key points

References

19.  Late-onset nyctalopia and widespread geographical atrophy

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Other features

Multimodal testing and results

Management and follow-up

Algorithm 19.1: Late-onset retinal macular degeneration (LORMD) flowchart

Key points

References

20.  Bilateral gradual visual decline with subtle parafoveal graying and refractile foci

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 20.1: Algorithm for retinal cysts/cavitations

Key points

References

21.  Transient peripheral white retinal lesions

History of present illness

Ocular examination findings

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Electroretinogram

Management

Follow-up care

Algorithm 21.1: Differential diagnosis and algorithm for nyctalopia

References

22.  Bilateral atypical drusen and slow dark adaptation in a woman

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 22.1: Algorithm for workup of reticular pseudodrusen: staging and differential diagnosis of their parent condition

Key points

References

23.  Bilateral diffuse macular and peripheral yellow spots

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 23.1: Differential diagnosis for cuticular drusen with vitelliform lesion

Key points

References

Section 3. Inflammatory/Autoimmune Macular Diseases

24.  Night blindness in a man with a normal fundus examination

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 24.1: Algorithm showing differential diagnosis for nyctalopia

Key points

References

25.  Hypopyon uveitis

History of present illness

Questions to ask

Ocular exam findings

Imaging

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 25.1: Approach to retinal whitening

Key points

References

26.  Treatment-resistant bilateral neurosensory macular detachment

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 26.1: Algorithm representing macular subretinal fluid in eyes without inflammation

Key points

References

27.  Malignant photopsias

History of present illness

Questions to ask

Ocular examination findings

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 27.1: Approach to photopsias

Key points

References

28.  Unilateral paracentral scotoma and photopsia in a young woman with myopia

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 28.1 Algorithm representing differential diagnosis for punctate inner choroidopathy (PIC)

Key points

References

29.  Persistent bilateral flashes with vitreous cell and haze

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Key points

Algorithm 29.1: Algorithm for photopsias

References

30.  Sudden-onset bilateral scotomas with punched-out, pigmented lesions

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 30.1: Differential diagnosis for multifocal choroiditis

Key points

References

31.  Bilateral munir-focal serous retinal detachments

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 31.1: Applicable differential diagnosis for serous retinal detachment

Key points

References

32.  Bilateral multifocal placoid lesions in a young woman

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 32.1: Algorithm for diagnosis of acute posterior multifocal placoid pigment epitheliopathy

Key points

References

33.  Bilateral progressive vision loss in an otherwise healthy man

History of present illness

Questions to ask

Assessment

Differential diagnosis

Multimodal testing and results

Management

Working diagnosis

Follow-up care

Algorithm 33.1: Algorithm for relentless placoid chorioretinitis

Key points

References

34.  Flashes and floaters with a well-demarcated peripapillary lesion of the right eye

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 34.1: Algorithm for differential diagnosis for acute zonal occult outer retinopathy

Key points

References

35.  Acute vision loss in a pregnant woman associated with bilateral serous retinal detachment

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Key points

Algorithm 35.1: Algorithm for bilateral subretinal fluid in a young patient

References

Section 4. Infectious Macular Diseases

36.  Unilateral vision loss in a 45-year-old woman

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 36.1: Algorithm for differential diagnosis for placoid retinal lesions

Key points

References

37.  Unilateral painless vision loss with retinal detachment

History of present illness

Questions to ask

Ocular exam findings and imaging

Differential diagnosis

Working diagnosis

Algorithm 37.1: General posterior uveitis differential diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithms

Key points

References

38.  Unilateral vitreous cell and chorioretinal lesions in an asymptomatic woman

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Key points

Algorithm 38.1 Algorithm for differential diagnosis of chorioretinal lesions

References

39.  Bilateral chorioretinal scars and pigment mottling in a newborn

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 39.1: Differential diagnosis for congenital chorioretinal scar

Key points

References

40.  Unilateral floaters and vitreous cells

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Examination/multimodal testing and results

Management

Follow-up care

Algorithm 40.1: Algorithm for chronic uveitis

Key points

References

Section 5. Retinovascular

41.  Bilateral retinal hemorrhages in a young man

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Systemic investigation

New working diagnosis

Multimodal retinal imaging

Management

Follow-up care

Key points

Algorithm 41.1: Algorithm for bilateral retinal hemorrhages in a young patient

References

42.  Multiple branch retinal artery occlusions in a woman

History of present illness

Questions to ask

Assessment

Differential diagnosis

Diagnosis

Multimodal imaging

Management

Follow-up care

Key points

Algorithm 42.1: Algorithm for differential diagnosis for susac syndrome

References

43.  Unilateral disc edema in an elderly woman

History of present illness

Questions to ask

Assessment

Differential diagnosis1,2

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 43.1: Giant cell arteritis

Key points

References

44.  Peripheral transient fluctuating retinal lesion

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management and follow-up care

Algorithm 44.1: Algorithm for differential diagnosis

Key points

References

45.  Acute vision loss with peripapillary cotton wool spots

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 45.1: Algorithm for peripapillary cotton wool spots

Key points

References

46.  Unilateral leukocoria

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Key points

References

47.  Sudden-onset unilateral vision loss in a young patient with a “cherry-red spot”

History of present illness

Questions to ask

Assessment

Diagnostic considerations

Differential diagnosis

Working diagnosis

Multimodal testing and results

Follow-up care

Algorithm 47.1: Cherry-red spot algorithm

Key points

References

48.  Takayasu arteritis: Bilateral progressive loss of vision with aneurysmal dilatation

History of present illness

Imaging

Questions to ask: What would you do next?

Differential diagnosis

Working diagnosis

Managment

Outcome and follow-up

Discussion

Key points

Algorithm 48.1: Algorithm for differential diagnosis and treatment

References

49.  Perifoveal retinal whitening and scotomas in a sickle cell patient

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 49.1: Paracentral acute middle maculopathy algorithm

Key points

References

Section 6. Idiopathic Macular Conditions

50.  A hypopigmented lesion in a baby’s eye

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing

Management

Algorithm 50.1: Algorithm for torpedo maculopathy

Follow-up

Key points

References

51.  Unilateral painless vision loss after a viral illness

History of present illness

Questions to ask

Assessment

Differential diagnosis (see algorithm 51.1 for full algorithm)

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 51.1: Algorithm for differential diagnosis of serous macular detachment

Key points

References

52.  Bilateral presentation of macular schisis in a woman

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 52.1: Algorithm for differential diagnosis of retinoschisis

Key points

References

53.  Bilateral vitelliform detachments in a woman

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 53.1: Differential diagnosis for vitelliform detachments

Key points

References

54.  Hypopigmented subretinal lesion in an elderly man

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 54.1: Algorithm for sclerochoroidal calcification

Key points

References

55.  Jello-like circles in my vision

History of present illness

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Algorithm 55.1: Algorithm for evaluation of scotoma

Follow up

Key points

References

Section 7. Toxic/Secondary

56.  Bilateral maculopathy in a middle-aged woman with interstitial cystitis

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal imaging

Management

Follow-up care

Key points

Algorithm 56.1: Algorithm for bilateral maculopathy with perifoveal retinal pigment epithelium (RPE) mottling

References

57.  Bilateral chronic photopsias in a woman

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Key points

Algorithm 57.1: chronic photopsias

References

58.  Bilateral serous retinal detachments in a man with metastatic melanoma

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 58.1: exudative retinal detachment workup, systemic associations, and fundus examination findings

Algorithm 58.2: Algorithm of exudative retinal detachment differential diagnoses

Key points

References

59.  Bilateral blurred vision and eye redness with bacillary and serous retinal detachments

History of present illness

Questions to ask (Fig. 59.2)

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Key points

References

60.  Bilateral decreased vision in a middle-aged man with optical coherence tomography findings of foveal ellipsoid disruption

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 60.1: Algorithm representing optical coherence tomography (OCT) finding of foveal outer-retinal disruption including a differential with some distinguishing characteristics

Key points

References

61.  Bilateral central scotoma with macular pigmentary changes in a young man

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 61.1: Algorithm representing the differential diagnosis of central macular pigmentary changes

Key points

References

Section 8. Neoplastic/Infiltrative

62.  Unilateral exudative retinal detachment in an elderly woman

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management and follow-up care

Algorithm 62.1: Algorithm showing differential diagnosis for unilateral serous retinal detachment

Key points

References

63.  Perifoveal calcified lesion in young girl patient

History of present illness

Questions to ask

Assessment

Differential diagnosis

Algorithm 63.1: Algorithm for calcified choroidal lesion in a young girl.ar histoplasmosis syndrome

Management

Follow-up

Algorithm 63.2: Algorithm showing management of choroidal osteoma

Key points

References

64.  Bilateral vitreous floaters

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm

Key points

References

65.  Familial dense vitreous floaters in a man

History of present illness

Questions to ask

Assessment

Differential diagnosis

Workup/diagnosis

Multimodal testing and imaging

Management

Follow-up care

Algorithm 65.1: Vitreous opacity flowchart

Key points

References

66.  Asymptomatic bilateral retinal white spots

History of present illness

Questions

Medical history

Assessment

Differential diagnosis

Workup

Diagnosis

Atypical lesions

Multimodal imaging

Management

Algorithm 66.1: Algorithm for retinal white spot

Key points

References

67.  Unilateral decreased vision associated with a peripheral mass in a young male patient

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 67.1: Differential diagnosis

Key points

References

68.  Peripheral proliferative retinal lesion

Introduction

History of present illness and examination

Differential diagnosis

Work up and imaging

Follow-up

Discussion

Algorithm 68.1: Algorithm of steps involved in diagnosing and managing asymptomatic fundus lesions

Conclusion and key points

References

69.  Bilateral severe vision loss in a middle-aged woman with constitutional symptoms

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 69.1: Algorithm for differential diagnosis for bilateral diffuse uveal melanocytic proliferation (BDUMP)

Key points

References

70.  Diffuse choroidal thickness in a patient with migraine headaches

History of present illness

Questions to ask

Assessment

Differential diagnosis

Multimodal testing and results

Working diagnosis

Management

Follow-up

Algorithm 70.1: Algorithm for management of diffuse choroidal hemangiomas

Key points

References

71.  Vascularized, pigmented macular lesion

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Flow chart

Algorithm 71.1: Algorithm for pigmented lesions in the posterior pole

Key points

References

72.  Unilateral macular lesion in a young ma n

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 72.1: An algorithm for the differential diagnosis of congenital simple hamartoma of the retinal pigment epithelium

Key points

References

73.  A young boy who failed routine school screening with unilateral decreased vision and an irregular reddish macular lesion

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Discussion

Multimodal imaging and testing

Management

Follow-up care

Algorithm 73.1: The diagnosis of a retinal cavernous hemangioma is generally straightforward

Key points

References

74.  Unilateral loss of vision with a vascular retinal lesion

History of present illness

Questions to ask

Assessment

Differential diagnosis

Working diagnosis

Multimodal testing and results

Management

Follow-up care

Algorithm 74.1: Algorithm for vascular lesion diagnosis

Key points

References

Index

 

An aparitie	28 iunie 2024
Autor	Jennifer I. Lim, William F. Mieler
Dimensiuni	152 x 229 mm
Editura	Elsevier
Format	Paperback
ISBN	9780128227206
Limba	Engleza
Nr pag	400
Versiune digitala	DA