Blurry vision and pneumonia in an elderly patient
Year: 2024
Type: article
Study design: Case Report
Abstract: A 73-year-old male presented with metamorphopsia and painless blurry vision in the left eye for 1 month. He was an asthmatic for the last 10 years and had recently completed 5 days of antibiotics for pneumonia. Best-corrected visual acuity was 6/9 N6 in the right eye and 6/18 N6 in the left eye. Both eyes were pseudophakic with normal intraocular pressure. Fundus examination of both eyes revealed clear media, normal disc, and multiple choroidal elevations over the posterior pole with inferior exudative retinal detachment [Fig. 1a and b].Figure 1: Ultrawide-field fundus imaging (OPTOS) revealed multifocal bumpy choroidal elevations over the posterior pole (white arrow) with inferior exudative retinal detachment (a and b). Fundus autofluorescence (FAF) revealed speckled pattern of hyper (red arrow) and hypo AF (yellow arrow) corresponding to the lesions (c and d). Swept-source optical coherence tomography (SS-OCT) revealed neurosensory retinal detachment (black arrow) overlying multiple bumpy choroidal elevations with hyper-reflective deposits on the RPE (black arrowhead) (a-d)What is your next step? Fundus fluorescein angiography Optical coherence tomography–enhanced depth (EDI-OCT) or swept-source (SS-OCT) imaging through the lesions. Anti-VEGF injection Emergency IV methylprednisolone. Findings SS-OCT [Fig. 2a and b] of both eyes showed a clear posterior vitreous, neurosensory retinal detachment overlying multiple bumpy choroidal elevations with hyper-reflective deposits on the RPE. Fundus autofluorescence (FAF) revealed a speckled pattern of hyper- and hypo-autofluorescence corresponding to the lesions [Fig. 1c and d]. On further questioning, he reported that he had undergone a chest X-ray and CT and was advised to undergo sputum testing for possible tuberculosis. The findings were suggestive of choroidal metastases, and he was referred to the oncologist. He was diagnosed with primary adenocarcinoma of the lung with systemic metastases including the eye and brain, and despite systemic treatment, he expired 3 months later.Figure 2: (a and b) Swept-Source Optical Coherence Tomography (SS-OCT) revealed neurosensory retinal detachment (Black arrow) overlying multiple bumpy choroidal elevations with hyper reflective deposits on the RPE (black arrowhead).Diagnosis Choroidal metastasis. Correct answer B. Investigations: EDI-OCT or SS-OCT imaging through the lesions. Discussion Choroidal metastases are the most prevalent intraocular cancer in the adult population, despite having previously been regarded as a rare condition.[1] Most patients with choroidal metastasis have known systemic cancer at the time of eye diagnosis, but in 34% of cases, choroidal metastasis precedes the diagnosis of systemic cancer.[1] EDI-OCT of choroidal metastasis shows a characteristic lumpy bumpy anterior tumor surface and outer retinal layer disruption with preservation of the inner retinal layer.[2] FAF in choroidal metastasis have shown a complete or a partial correlation between increase in the AF signals and hyperpigmented lesions.[3] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.
Source: Indian Journal of Ophthalmology
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4403850411