Specialists delve deep to unravel retinal mysteries

Everybody loves a good detective mystery and retinal specialists are no exception. 

At the Medical Retina Mystery Cases session, the assembled audience was presented with a wide variety of puzzling case studies which highlighted the complex process of arriving at a correct diagnosis.

Opening the session, Srinivas Sadda MD presented the intriguing case of a 59-year-old female who had been diagnosed with central serous chorioretinopathy (CSCR) 31 years previously. Two months prior to assessment she noted new distortion in both eyes and was referred to a local retina specialist and then onwards to Dr Sadda. She was not on any medication and her visual acuity was 20/20 in both eyes. The patient was ultimately found to have paraneoplastic acute exudative polymorphous vitelliform maculopathy, a rare and poorly understood retinal disorder that may be idiopathic or may manifest in patients with malignancies.

Camille Boon MD, PhD, then presented the case of a 30-year-old who presented with marked visual disturbances and photopohobia who had received chemotherapy treatment for leukemia as a child. After two and five months he showed some improvement in his anatomical and functional measurements and his photophobia had greatly improved. It turned out that the patient had taken an overdose of Sildenafil (Viagra) which has been shown in the scientific literature to increase photocurrent and light sensitivity of the retinal cones.

Sarah Mreken MD presented the case of a 57-year-old male who had been referred to the emergency room for an acute bilateral retinal detachment. After steroid treatment, there was no improvement or change in the patient’s condition. The patient was finally found to have bullous central serous chorioretinopathy (bCSCR), a rare variant of the central serous chorioretinopathy, complicated by an exudative retinal detachment with shifting fluid.

Roberto-Gallego Pinazo MD presented the case of a 15-year-old female with recent vision loss. She was under immunotherapy since 2014 due to various allergies and had been vaccinated for papillomavirus (PPV) about one year previously. The differential diagnosis included retinal dystrophy, acute macular neuroretinitis, auto-immune retinopathy, cancer associated retinopathy or paraneoplastic syndrome. To the surprise of the treating physicians, her issues resolved without any interventional medical treatment and her vision returned to normal. “The case remains a mystery to this day,” remarked Dr Pinazo, noting that the PPV vaccination was one working hypothesis as to why she had encountered sudden vision issues.

Other intriguing diagnostic conundrums in the session were presented by Rosa Dolz-Marco MD, Anna CS Tan MD, and William F Mieler MD.