A White woman in her 40s was referred to an outside ophthalmologist after developing nausea and a headache following a dilated eye examination. She was found to have narrow angles in both eyes and a laser peripheral iridotomy (LPI) was performed in her left eye. Two weeks later she developed flickering photopsias and a temporal scotoma progressing to a “brown tint” of her vision in her left eye. Her vision had decreased in her left eye and macular and optic nerve edema were noted and she was subsequently referred to us. In our clinic, her visual acuity was 20/20 OD and 20/50 OS, and she had normal intraocular pressure, a shallow anterior chamber but open angle in both eyes, a patent LPI in the left eye, and clear crystalline lenses in both eyes. The rest of her anterior segment was unremarkable. The posterior examination was notable for shifting subretinal fluid with choroidal detachments without retinal breaks, inflammation, or optic nerve edema and leopard spotting, while her right eye was unremarkable (Figure, A). Fluorescein angiography was unrevealing, while optical coherence tomography showed shallow subretinal fluid and an irregular and thickened choroid (Figure, B). Ultrasonography showed an axial length of 20.0 mm, thickened sclera, anteriorly rotated ciliary body, and 360° of ciliochoroidal detachments in both eyes but worse in the left eye. Results of a systemic laboratory evaluation for infectious and noninfectious disorders were unremarkable. Systemic corticosteroids failed to resolve the subretinal fluid and her vision declined.
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Corresponding Author: Christopher D. Conrady, MD, PhD, Department of Ophthalmology, University of Nebraska Medical Center, 3902 Leavenworth St, Omaha, NE 68105 (email@example.com).
Published Online: February 10, 2022. doi:10.1001/jamaophthalmol.2021.4988
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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