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| CLINICAL QUIZ |
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| Year : 2018 | Volume
: 11
| Issue : 2 | Page : 187 |
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Sudden paracentral scotoma in a middle-aged male
Reem Al Motaem, Mohammed Al Abri
Finland Eye Center, Muscat, Oman
| Date of Web Publication | 28-May-2018 |
Correspondence Address:
Reem Al Motaem
Finland Eye Center, Muscat
Oman
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ojo.OJO_108_2017
How to cite this article:
Al Motaem R, Al Abri M. Sudden paracentral scotoma in a middle-aged male. Oman J Ophthalmol 2018;11:187 |
A 40-year-old male presented with a 1-day history of the right eye paracentral scotoma.
Medical history revealed diabetes mellitus (DM) for 10 years and hyperlipidemia, on medications.
Best-corrected visual acuity was 20/20 (with − 0.75–0.75 × 90) OD and 20/20 (with − 0.75–0.75 × 80) OS.
Intraocular pressure (IOP) (mmHg) was 21 OD and 22 OS. Anterior segment examination was unremarkable OU.
Dilated funds examination revealed abnormal findings OD [Figure l]a along with optical coherence tomography (OCT) macula [Figure 1]b, otherwise mild nonproliferative diabetic retinopathy changes OU. His systemic review was unremarkable. | Figure 1: (a) Fundus photograph, (b) macular optical coherence tomography, (c) late phase of fundus fluorescein
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 Questions | |  |
- What are the abnormal retinal findings as shown in [Figure 1]a,[Figure 1]b,[Figure 1]c?
- What is the differential diagnosis?
- What is most likely the diagnosis based on history, clinical examination, and investigations?
- What is the proper management in such case?
For answers please see page 192.
 View Answer
[TAG:2]Answers[/TAG:2] - Abnormal retinal findings
- Fundus photograph shows cloudy white edematous retina superonasal to the fovea
- OCT macula shows thickening of the retinal nerve fiber layer superonasal to the fovea corresponding to the changes in fundus photograph
- Fluorescein angiography shows hypofluroscence of involved segment, multiple microaneurysms, with no obvious emboli.
- Differential diagnosis:
- Branch retinal artery occlusion (BRAO)
- Cilioretinal artery occlusion.
- Retinal artery macroaneurysm
- Most likely diagnosis: BRAO.
- The management:
- Lower IOP: Topical and systemic IOP-lowering medications
- Ocular massage
- Control high blood pressure (BP) and other relevant risk factors (DM, hyperlipidemia etc.)
In this patient, BP was found to be 190/100 mmHg for which was referred to an internist for the further management of hypertension.{Figure 2} The clinical diagnosis in this young man revealed right eye BRAO, and with aforementioned management measures, the patient showed improvement in scotoma and resolution of the white edematous area as shown below [Figure 2]a and [Figure 2]b. Declaration of patient consentThe 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 sponsorshipNil. Conflicts of interestThere are no conflicts of interest.
[Figure 1]
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