A 90-year-old woman with a history of dry age-related macular degeneration in both eyes noticed blurred vision in her left eye after she rubbed her right eye. She had undergone cataract surgery in both eyes 10 years earlier and was pseudophakic.
A 90-year-old woman with a history of dry age-related macular degeneration in both eyes noticed blurred vision in her left eye after she rubbed her right eye. She had undergone cataract surgery in both eyes 10 years earlier and was pseudophakic. She was otherwise in good health and took only aspirin, 81 mg/d, and a multivitamin.
The patient's best corrected visual acuity was 20/25 in the right eye and 20/400 in the left. There was no afferent pupillary defect. The slit-lamp examination showed well-positioned posterior chamber intraocular lens implants in both eyes. The intraocular pressures were normal. The funduscopic examination of the right eye showed a healthy optic nerve and some mild macular mottling. Examination of the left eye showed a healthy optic nerve and revealed evidence of macular edema and hemorrhage.
A fluorescein angiogram identified an occult subretinal neovascular membrane as the cause of this patient's wet macular degeneration.Wet macular degeneration causes more severe vision loss than the dry form does, although the latter is more common. Macular edema and hemorrhaging are classic findings of wet macular degeneration. Special tests--such as fluorescein angiography--are used to differentiate between dry and wet macular degeneration and, in cases of wet macular degeneration, to distinguish between classic and occult subretinal neovascular membranes. Classic membranes may be treated with laser photodynamic therapy; occult membranes (the diagnosis in this patient) are treated with intraocular injections of antivascular endothelial growth factor agents such as pegaptanib sodium.