To see views enlarged, click on the individual pictures...

A 79-year-old treated three months previously with photodynamic therapy OS presents (as above, left) with a worsening scotoma in that eye and a visual acuity of 20/40.  Fluorescein angiography and an OCT were performed (as shown above, middle, right).

1.	Based on the OCT and FA findings, what best and most fully describes the patient’s retinal findings?
	a. subretinal cyst b. geographic atrophy consistent with “dry” macular degeneration c. pigment epithelial detachment d.  bullous cystoid macular edema e. choroidal rupture

During the same visit when the aforementioned studies were performed, it was decided to administer an intravitreal injection of Avastin to the patient’s left eye in an attempt to mitigate the scotoma and improve her visual acuity.  And while the patient reported some stability two weeks post-injection, she did note a mild decrease in visual acuity (20/50+) at her 7-week visit, although she was no longer troubled by metamorphopsias.

2.	Based on the striking FA and OCT findings at the follow-up visit, how would you describe the retina after undergoing the Avastin treatment?
	a. as ischemic b. as being less cystic c. as essentially normal d.  as having suffered a pigment epithelial “tear” or “rip” e. as having increased choroidal neovascularity
3.	What would you surmise is responsible for the findings at follow-up?
	a. natural progression of macular degenerative disease b. rapid, Avastin-induced shrinkage of fibrous neovascular elements with subsequent tearing of the pigment epithelium c. original photodymanic therapy session, as PDT is well-documented to need several months for maximal effect d.  pigment epithelial atrophy common  in “dry” macular degeneration e. pneumatic displacement of neovascular elements

For answers to the above, click here on or after April 17, 2007.