case of acute macular degeneration

8/9/2019 Case of Acute Macular Degeneration

1/5

CASE of AMDPATIENT PROFILE:Patient is MQ 62/F, domestic worker, Roman Catholic, widowed from Manila who came inwith a chief comlaint of !l"rrin# of $ision, %D&

History of Present Illness:

' (ear P)C, atient noted slowl( ro#ressi$e !l"rrin# of $ision *characteri+ed as dic"lt(foc"sin# eseciall( distant o!-ects. occasionall( associated with tearin#& ot associated with0ashes/0oaters, hotoho!ia, $is"al 1eld c"ts, and e(e ain&

6 months P)C, atient cons"lted an otical sho and was rescri!ed with readin# #lasseswhich imro$ed her near$ision&

3n the interim, !l"rrin# of $ision, %D, worsened, associated with occasional holocranialheadache, di++iness, and tearin#, %D&

Persistence of s(mtoms romted cons"lt at S%4R&

Review of Systems:*. Fe$er*. 5ei#ht loss*. 3nsomnia*. Co"#h*. Colds*. Dic"lt( of !reathin#*. %rthonea

*. A!dominal ain *R7Q.*. Constiation*. oct"ria *89/ni#ht.*. Pol(disia*. "m!ness*. 4oint ains*.Edema

Past Medical History*. Pre$io"s tra"ma: ';ehic"lar crash, con1ned for ' week*. ?(ertension*@. DM *ne$er !een checked.*. aller#(*. ronchial asthma

Family Medical History*. ?(ertension*@. DM*. heart disease mother*. !l"rrin# of $ision *"nrecalled ca"se. = #randmother

O!"#N HistoryBP*. all deli$ered $ia S>D witho"t fetomaternal comlicationss/ li#ation last ';


2/5

?EE) Anicteric sclerae, ink ale!ral con-"ncti$ae*oint e(e e9am to follow.

Chest EH"al chest e9ansion, Clear !reath so"nds

C>S Ad(namic recordi"m, distinct heart so"nds,

A!domen Fla!!(, soft a!domen

E9tremties F"ll eH"al "lses, ink nail !eds, *. edema

'!(oint eye e)am>is"al Ac"it( sc h

%D 2/ ' 3P?

%S 2/2 2 2/2

Bross E(e E9am

E9traoc"lar

mo$ements

Di#ital )onometr(

%D Soft

%S Soft

F"ndosco( %D *. R%R, A>R 2:8, Clear media, $essels seen

%S *. R%R, A>R 2:8, Clear media, $essels seen

Ot$er oc*lar tests

3ndirect%hthalmosco(

%D *. R%R, A>R 2:8, Clear media, CDR &, *. Dr"sen,withh(oi#mented areas on the retina *RPE chan#es.

%S *. R%R, A>R 2:8, Clear media, CDR & *.hemorrha#es/e9"dates

Amsler Brid %D *. distortion *. scotoma

%S *. distortion *. scotoma

+IFFERENTIAL +IA"NOSES

Most li,ely Least li,ely'& A#eRelated Mac"larDe#eneration

?istor(: l"rrin# of $ision,a#e, #enderPE: Presence of dr"sen andRPE chan#es on 3%

2& Dia!etic Retinoath( ?istor(: !l"rrin# of $ision,"nknown histor( of DM,

ol(disia and noct"ria onR%S,

*. microane"r(sms *ande9"dates.on 3%

8& Senile Cataract ?istor(: l"rrin# of $ision,a#e

*. hotoho!iaBrossl( clear lenses

& ?(ertensi$e Retinoath( ?istor(: l"rrin# of $ision o doc"mented h(ertensi$eeisodes*. narrowin# of $essels

+ia-nostic Tests


3/5

• Fl"orescein an#io#rah( can !e "sed to $is"ali+e the $asc"lari+ation of the retina&

)his ma( e9hi!it neo$asc"lari+ation, microane"r(sms and narrowin# or ischemia ofretinal $essels&

• FS ma( !e taken to con1rm the resence of dia!etes

• ?!A'c ma( !e taken to check #l"cose control for the ast 8 months&

Primary wor,in- im(ression:A"E!RELATE+ MA%.LAR +E"ENERATION /non!e)*dative01 O+

+IS%.SSION: A#e Related Mac"lar De#eneration, %Dac,-ro*nd

A#erelated mac"lar de#eneration *AMD. is the leadin# ca"se of loss of $ision and$is"al disa!ilit( in most Ca"casians a#ed I6 (ears eseciall( in E"roe and orth Americacharacteri+ed with clinical 1ndin#s of dr"sen and retinal i#ment eitheli"m *RPE. chan#eswhich are not ca"sed !( a secondar( disorder& 7ater sta#es ma( manifest with $is"alimairments&

Dr"sen are e9tracell"lar deosits which are tho"#ht to !e !(rod"cts deri$ed fromimm"nemediated and meta!olic rocesses in the RPE& )hese are located !etween the RPE

and r"ch mem!rane& )ho"#h the e9act athoh(siolo#( of the aearance of dr"sen is not(et de1ned, it is "s"all( associated with increase in a#e&AMD is ca"sed !( m"ltile interactions !etween #enetic and en$ironmental factors& Riskfactors are as follows:

A-e

• Ca"casian race

• Famil( histor( *m"tation of

chromosome 'H82.

• Smokin#

?(ertension and other

cardiovasc*lar ris, factors

• %!esit(

• %thers: histor( of cataract s"r#er(,

!l"e iris color1 $i-$ s*nli-$te)(os*re, female se9


4/5

•

• Classi1cation

• AMD can !e classi1ed in two wa(s

•

• First classi1cation cate#ori+es the resence of a!normal neo$asc"lari+ation

23 +ry /non!e)*dative0 AM+

• most common form *I;G.J clinicall( manifests as #eo#rahic atroh( *BA. inad$anced sta#es

2& 5et *e9"dati$e. AMD

• m"ch less common and is associated with a more a##ressi$e co"rse ca"sin# si#ht

lossJ clinicall( manifests as choroidal neo$asc"lari+ation *C>. and i#menteithelial detachment

•

• Second classi1es AMD accordin# to e9tent of $is"al imairment *)he 3nternationalA#eRelated Mac"loath( Eidemiolo#ical St"d( Bro".

23 Early AM+ = characteri+ed !( medi"mlar#e dr"sen, RPE h(eri#mentation and/orh(oi#mentation

2& Ad$anced AMD = with BA and C>

•

• )he co"rse of this disease !e#ins in the r"chKs mem!rane and RPE later

res"ltin# in sro"tin# of $essels in the choriocaillaris& At the aearance of C>,there is note of s"dden worsenin# of $ision *central $ision.& At the endsta#e disease,these will res"lt in 1!ro$asc"lar or atrohic mac"lar scar ca"sin# ermanent dama#ein central $ision&

•

•

• AMD ro#ression: from earl( AMD to late AMD

•

%linical Presentation

• Patients can comlain of distortion, !l"rrin# or a scotoma in their central

$ision, in either one or !oth e(es& 7ate AMD ma( resent with $is"al hall"cinations&

•

• %n f"ndosco(, AMD encomasses the followin# 1ndin#s:

dr"sen, h(erlasia of the retinal i#ment eitheli"m *RPE., #eo#rahic atroh( andchoroidal neo$asc"lari+ation *C>.& Patients with dr"sen and mild RPE chan#es ma( stillha$e normal $ision& Areas of central distortion or scotoma ma( !e detected on Amsler #rid&'2 dr"sen are said to ha$e low risk in ro#ression to ad$anced AMD& Fl"oresceinan#io#rah( is eseciall( helf"l for atients with wet AMD in assessin# the s"ita!ilit( of some treatment modalities& 3t ma( also show a window defect d"e to "nmaskin# !ack#ro"ndof choroidal 0"orsence& %ther dia#nostic tests that ma( !e "sed is an %tical coherence


5/5

tomo#rah( which shows the crosssectional ima#e of the retina, RPE and choroid& )his ma(determine the resence of i#ment eithelial detachments&

•

• O.R PATIENT came in with chief comlaint of slow ro#ressi$e !l"rrin# of $ision of

the ri#ht e(e& ?er risk factors for AMD are her a#e, female #ender and re$io"ss"nli#ht e9os"re& %n her indirect ohthalmosco(, there was note of dr"sen and

RPE chan#es with no note of neo$asc"lari+ation and hemorrha#es and e9"dates& )his"ts her in the cate#or( of dr( AMD& As disc"ssed earlier, dr( AMD with '2 dr"sendoes not "s"all( ro#ress into more serio"s sta#es&

•

Treatment

• For none9"dati$e AMD, monitorin# of ossi!le disease ro#ression is needed!( re#"lar follow"s with the ohthalmolo#ist or ro$ision of low $ision aids&Proh(lactic treatment ma( !e #i$en s"ch as antio9idant s"lementation anda$oidance of the modi1a!le risk factors&

• )here are some inter$entions that ma( hel in the imro$ement of $ision *e&

miniat"re intraoc"lar telescoe and laser hotocoa#"lation.J howe$er, these arehi#hrisk roced"res and are still e9erimental&

•

• Reference:

• S3M of %hthalmalo#( 2'2

• Lanski Clinical %hthalmolo#(, th ed

•

case of acute macular degeneration

Documents