This rare case uploaded by Mr Armin Moradi . Case content generously contributed by Dr. Bernard Hurley at the University of Ottawa Eye Institute.
62yo male complaining of blurry vision for 6 months 'wavy' visual distortion.
The differential diagnosis is as follows:
The following investigation results are available:
OCT is key. Hyporeflective *inner* retinal cavities. Inner lamellar cysts that enlarge with progressive disease. Thinning and/or disruption of the ISOS junction (photoreceptor layer).
The accepted diagnosis is Macular Telangiectasia.
The management of this condition is as follows:
Things to look for on fundus exam: retinal loss of transparency which can make the retina look greyish, possibly crystalline deposits, retinal pigment epithelial hyperpigmentation, and perifoveal telangiectactic vessels (Ryan's Retina). Additionally, aneurysms are uncommon, but RPE plaques can be seen which are often associated with right-angled venules. Pay close attention to OCT findings of INNER retinal cavities and disruption of ISOS junction with or without RPE thinning which does not look like geographic atrophy.
Ryan's Retina 6th ed pg 1180-1187. Kanski's clinical ophthalmology 8th ed pg 627-630. MacTel Project.