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A 45-year-old man presented with floaters in his left eye and headaches for 2 months. He experienced left temporal field loss when lifting heavy objects. He took no medications and denied prior surgery, eye trauma, or pain. His best-corrected visual acuity was 20/25 OD and 20/30 OS. The only abnormalities on bilateral eye examination were 1+ levels of anterior vitreous cells and trace levels of posterior vitreous cells in the left eye, without vitreous haze, and a left retinal detachment extending from 1:30 to 10:00 o’clock, with macular involvement and without visible retinal tears. There were 360° left choroidal detachments.
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Type 3 uveal effusion syndrome
B. Surgery to create scleral windows
Diagnostic vitrectomy with cytologic testing (choice A) would be appropriate for suspected primary vitreoretinal lymphoma with so-called leopard-spot lymphomatous infiltration under the retinal pigment epithelium, but there were few vitreous cells seen in this case. Choroidal thickening and exudation might occur in choroidal lymphoma, but this diagnosis would likely require tissue biopsy rather than vitreous biopsy.
Rhegmatogenous detachment should always be reconsidered when presumed exudative detachments do not resolve with initial treatment. Surgical repair with a scleral buckle (choice C) would then be appropriate. However, this patient had repeated fundus examinations and ultrasonographic images that did not reveal retinal tears. Also, there was no vitreous pigment and no stiffening of the retina.
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Corresponding Author: Janet L. Davis, MD, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St, Miami, FL 33136 (firstname.lastname@example.org).
Published Online: July 11, 2019. doi:10.1001/jamaophthalmol.2019.1638
Conflict of Interest Disclosures: Dr Davis reports grants from Johns Hopkins, Eye Pharma, and Nightstar Therapeutics and personal consulting fees from Abbvie for participation in a steering committee and Allergan for participation in a data safety monitoring board, outside of the submitted work. No other disclosures were reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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