PMC4847605_01
Initial fundus photographs of the right eye with fluorescein angiography transit show vertical lacquer crack in the fovea (February 2012).
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Choroidal dystrophy was suspected in Damascus (Syria) (Figures 1 and 2).
Initial fundus photographs of the left eye with fluorescein angiography transit show an unaffected macula (February 2012).. Note: Routine view of a fluorescein angiogram: color, red free, and two transits of dye.
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Choroidal dystrophy was suspected in Damascus (Syria) (Figures 1 and 2).
Fundus photographs taken 6 months after initial photographs.. Notes: Images show more widening of the lacquer crack in the right eye (A) with no changes observed in the left fovea (B) (September 2012). The right eye underwent three monthly intravitreal injections just after this photographic capture.
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She subsequently received three monthly intravitreal ranibizumab injections in Barcelona (Spain) (Figure 3A and B).
Fundus photographs of the right (A) and left (B) eyes 27 months after the first fundus examination.. Notes: There is further enlargement of the lacquer crack in both eyes (May 2014). Enlargement continued through until February 2015 (3 years after the initial photographs were taken).
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Fundoscopy revealed definite widening of the vertical macular choroidal rupture bilaterally (Figure 4A and B).
External appearance of the neck area revealed tiny pinkish papules.
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The skin of the neck had tiny pinkish papules suspicious for early goose flesh (Figure 5).
High-definition horizontal OCT scan of left optic disc and macula showing the sites of Bruch's membrane rupture (arrows).. Note: The fovea is attenuated with marked distortions in the inner segment/outer segment junction (October 2014).. Abbreviation: OCT, optical coherence tomography.
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Our working diagnosis was lacquer crack from high myopia (without pseudoxanthoma elasticum) (Figure 6) possibly initiated by LASIK and exacerbated by ocular rubbing and intravitreal injections (Figure 7).
Proposed pathophysiology of lacquer crack formation and expansion in the current case.. Abbreviation: LASIK, laser in situ keratomileusis.
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Our working diagnosis was lacquer crack from high myopia (without pseudoxanthoma elasticum) (Figure 6) possibly initiated by LASIK and exacerbated by ocular rubbing and intravitreal injections (Figure 7).