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Global Health

A Retinal Detachment After International Travel

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.

1 Credit CME

JAMA Ophthalmology

Published Online: December 16, 2021

JAMA Ophthalmology Clinical Challenge

Article Information and Disclosures

Dilru C. Amarasekera, MD¹;

Michael J. Ammar, MD¹;

James P. Dunn, MD¹

Author Affiliations

¹Retina Division, Wills Eye Hospital, Philadelphia, Pennsylvania

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A 58-year-old man was referred for evaluation of a retinal detachment in his left eye. His visual acuity on presentation was 20/20 in the right eye and hand motion only in the left eye. Examination of the right eye was normal. Anterior segment examination of the left eye revealed around 30 cells per high-power field of a 1 mm × 1 mm light beam and diffuse stellate-appearing keratic precipitates. Posterior examination results showed a vitreous cell that precluded a clear view of the posterior pole and inferior snow banking. Most notable was a large, white, preretinal lesion in the inferior macula and a near-total retinal detachment with no identifiable retinal break and shifting subretinal fluid (Figure).

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A 58-year-old man was referred for evaluation of a retinal detachment in his left eye. His visual acuity on presentation was 20/20 in the right eye and hand motion only in the left eye. Examination of the right eye was normal. Anterior segment examination of the left eye revealed around 30 cells per high-power field of a 1 mm × 1 mm light beam and diffuse stellate-appearing keratic precipitates. Posterior examination results showed a vitreous cell that precluded a clear view of the posterior pole and inferior snow banking. Most notable was a large, white, preretinal lesion in the inferior macula and a near-total retinal detachment with no identifiable retinal break and shifting subretinal fluid (Figure).

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Article Information

Corresponding Author: James P. Dunn, MD, Retina Division, Wills Eye Hospital, 840 Walnut St, Ste 1020, Philadelphia, PA 19107 (jpdunn@willseye.org).

Published Online: December 16, 2021. doi:10.1001/jamaophthalmol.2021.2733

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References

Dixon WG , Symmons DPM , Lunt M , Watson KD , Hyrich KL , Silman AJ ; British Society for Rheumatology Biologics Register Control Centre Consortium; British Society for Rheumatology Biologics Register. Serious infection following anti-tumor necrosis factor alpha therapy in patients with rheumatoid arthritis: lessons from interpreting data from observational studies. Arthritis Rheum. 2007;56(9):2896-2904. doi:10.1002/art.22808 PubMed Google Scholar Crossref

Holland GN . Ocular toxoplasmosis: a global reassessment, part II: disease manifestations and management. Am J Ophthalmol. 2004;137(1):1-17. doi:10.1016/S0002-9394(03)01319-9 PubMed Google Scholar

Bonfioli AA , Orefice F . Toxoplasmosis. Semin Ophthalmol. 2005;20(3):129-141. doi:10.1080/08820530500231961 PubMed Google Scholar Crossref

Song A , Scott IU , Davis JL , Lam BL . Atypical anterior optic neuropathy caused by toxoplasmosis. Am J Ophthalmol. 2002;133(1):162-164. doi:10.1016/S0002-9394(01)01211-9 PubMed Google Scholar Crossref

Eyles DE , Coleman N . Antibiotics in the treatment of toxoplasmosis. Am J Trop Med Hyg. 1953;2(1):64-69. doi:10.4269/ajtmh.1953.2.64 PubMed Google Scholar Crossref

Holland GN , Lewis KG . An update on current practices in the management of ocular toxoplasmosis. Am J Ophthalmol. 2002;134(1):102-114. doi:10.1016/S0002-9394(02)01526-X PubMed Google Scholar Crossref

Bosch-Driessen LH , Karimi S , Stilma JS , Rothova A . Retinal detachment in ocular toxoplasmosis. Ophthalmology. 2000;107(1):36-40. doi:10.1016/S0161-6420(99)00013-5 PubMed Google Scholar Crossref

Bosch-Driessen LEH , Berendschot TTJM , Ongkosuwito JV , Rothova A . Ocular toxoplasmosis: clinical features and prognosis of 154 patients. Ophthalmology. 2002;109(5):869-878. doi:10.1016/S0161-6420(02)00990-9 PubMed Google Scholar Crossref

Hofman P , Drici MD , Gibelin P , Michiels JF , Thyss A . Prevalence of toxoplasma myocarditis in patients with the acquired immunodeficiency syndrome. Br Heart J. 1993;70(4):376-381. doi:10.1136/hrt.70.4.376 PubMed Google Scholar Crossref

Albrecht H , Stellbrink HJ , Fenske S , Schäfer H , Greten H . Successful treatment of Toxoplasma gondii myocarditis in an AIDS patient. Eur J Clin Microbiol Infect Dis. 1994;13(6):500-504. doi:10.1007/BF01974642 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.