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A 38-year-old man was referred to the medical retina service for evaluation of bilateral macular lesions noted by his general ophthalmologist. Medical history was otherwise unremarkable. On examination, his best-corrected visual acuity was 20/20 OU, although his vision was slightly eccentric. His pupils were round and reactive. The slitlamp examination of the anterior segment was unremarkable. Dilated fundus examination revealed subtle bilateral yellow foveal spots. Optical coherence tomography (OCT) displayed the presence of a bilateral foveal defect of the external limiting membrane and ellipsoid zone bands (Figure).
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C. Obtain an in-depth medical and personal history, including drug history
Poppers is a term for the chemical class of alkyl nitrites, which are inhaled for recreational drug purposes, typically for the high or rush that the drug may produce. Poppers have also been historically used by men who have sex with men for their ability to relax the anal sphincter. Although poppers are illegal, they can be purchased in some countries as alternative products, which include room deodorizers or video head cleaners.1 The use of poppers is thought to be high and ranges between 5% to 6% in French teenagers2 and up to 10% of adults in the United Kingdom.1 However, their use may be higher in certain groups and is estimated to be about 60% in Australia’s gay community.3
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Corresponding Author: Giuseppe Querques, MD, PhD, Department of Ophthalmology, Hospital San Raffaele, University Vita Salute San Raffaele, Via Olgettina 60, Milan 20132, Italy (firstname.lastname@example.org).
Published Online: September 19, 2019. doi:10.1001/jamaophthalmol.2019.3643
Conflict of Interest Disclosures: Dr Querques reports personal fees from Alimera Sciences, Allergan, Bayer, KBH, LumiThera, Novartis, Zeiss, Topcon, Roche, Heidelberg Pharma, SIFI, Bausch + Lomb, Sooft-Fidia, and Sandoz outside 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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