An 84-year-old woman presents with loss of vision in the left eye of 4 days of evolution accompanied by metamorphopsia. The macula shows abundant hard exudates, two small deep hemorrhages and a localized neurosensory retinal detachment. In the contralateral eye there are abundant soft drusen. Given this picture, which of the following diagnoses do you think is the most likely?
In principle, this is an easy question, as it deals with a disease that is frequently repeated in the MIR exams. The description is typical of option 2. It is an exudative AMD (although as we said in question 215, with the new classification, we would speak of an advanced AMD in its neovascular variant). In any case, we have an elderly patient with vision loss and metamorphopsia in one eye. In the examination there are lesions in the macula. With that we can rule out acute posterior vitreous detachment, which does not produce visual loss, nor metamorphopsia, nor lesions in the macula. And also non-arteritic anterior ischemic optic neuropathy, because although it produces visual loss and is typical of older people, it does not produce metamorphopsia. And there are no lesions in the macula but papilla edema. In central retinal artery obstruction, metamorphopsia is not particularly characteristic (visual loss and advanced age are), but the lesions in the fundus of the eye vary. In the case of arterial occlusion, there is intracellular edema that is seen as absence of hemorrhages and a whitish, pale fundus. In addition, the entire retina is globally affected, and a cherry-red spot may appear in the macula. In this case the lesions are totally different. They describe hard exudates, deep hemorrhages and localized neurosensory retinal detachment. All this in the macula. These are the characteristic findings of neovascular (or exudative) AMD. As a clue, in the other eye there are abundant soft drusen. Drusen are the typical findings of AMD. So he has AMD in both eyes and in the right eye it has recently become complicated by the appearance of neovascularization.
Acute posterior vitreous detachment.
Exudative age-related macular degeneration (AMD).
Central retinal artery obstruction.
Non-arteritic anterior ischemic optic neuropathy.
In the examination there are lesions in the macula. With that we can rule out acute posterior vitreous detachment, which does not produce visual loss, nor metamorphopsia, nor lesions in the macula.
They describe hard exudates, deep hemorrhages and localized neurosensory retinal detachment. All this in the macula. These are the characteristic findings of neovascular (or exudative) AMD.
In the case of arterial occlusion, there is intracellular edema that is seen as absence of hemorrhages and a whitish, pale fundus. In addition, the entire retina is globally affected, and a cherry-red spot may appear in the macula. In this case the lesions are totally different.
And also non-arteritic anterior ischemic optic neuropathy, because although it produces visual loss and is typical of older people, it does not produce metamorphopsia.