Case of the Month
Edited by Robert N. Johnson, MD
Case #114, December, 2018
Michelle Peng, MD
A 14-year-old Caucasian boy with sudden monocular vision loss following soccer injury
Figure 1: Wide-field color photo of the left eye. Note the area of retinal whitening extending from the macula to the periphery as well as scattered areas of retinal and vitreous hemorrhage. The inset detail shows the whitening in the superior part of the macula and hemorrhage in the fovea.
A 14-year-old healthy Caucasian boy presented with sudden onset vision loss in the left eye after he was hit in the face with a soccer ball.
On examination, visual acuity was 20/16 in the right eye and 1/200 in the left eye. The right eye was unremarkable. His left eyelid was mildly swollen. Fundus examination showed temporal vitreous hemorrhage, a macular hole with intraretinal hemorrhage, as well as superotemporal peripheral retinal whitening (Figure 1). Ocular coherence tomography displayed a full thickness macular hole with a focal macular detachment (Figure 2). Fluorescein angiography revealed focal leakage in the area of superior retinal whitening (Figure 3). Fundus autofluoresence displayed hyperautofluorescence in the region of retinal whitening (Figure 4).
Figure 2: Spectral domain OCT of the left eye. Note the full-thickness macular hole and the overlying area of vitreous opacities. The hyaloid still appears to be attached centrally.
Figure 3: Wide-field fluorescein angiogram of the left eye. Note the prominent area of fluorescein leakage in the posterior pole.
Figure 4: Wide-field autoflourescence scan of the left eye. Note the areas of increased autofluorescence superior to the macula.
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