PMC4284045_01
Serial OCT scans, right eye in left column and left eye in right column.. Notes: Outer cystic retinal edema prior to cataract extraction (A and B). Increased cystic edema OU and SRF OD after cataract extraction; choroidal thickness demarcated by white arrows (C and D). Resolved edema and SRF after starting acetazolamide (E and F). Mild return of edema at temporal disc border when carbonic anhydrase inhibitors were stopped (G and H).. Abbreviations: OCT, optical coherence tomography; OU, oculus uterque (both eyes); SRF, subretinal fluid; OD, oculus dexter (right eye).
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Several months earlier, he had developed blurred vision attributed to macular edema (Figure 1A and B) and cataract. Enhanced-depth imaging optical coherence tomography (OCT) for both maculae demonstrated thick choroids (496 mum OD and 537 mum OS) and outer retinal edema extending from the disc into the macula with subretinal fluid OD (Figure 1C and 1D). Attempting to avoid surgical intervention and frustrated with the lack of response to intravitreal triamcinolone and bevacizumab, the patient was started on a trial of acetazolamide, 500 mg extended-release sequels orally twice a day; subretinal fluid and edema were promptly resolved in both eyes (Figure 1E and F). Within a month, the edema recurred and threatened the macula of the right eye greater than the left (Figure 1G and H).
Composite fundus images.. Notes: Color photographs show healthy discs, temporal peripapillary crescents, and choroidal folds (A and B). Fluorescein angiograms demonstrated no macular retinal epithelial decompensation, although the crescents stained in the late phase (C and D). Late hyperfluorescence suggests hyperpermeability in the posterior pole on an ICGA (E and F).. Abbreviation: ICGA, indocyanine green angiogram.
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The discs were free of pit, tilt, and coloboma (Figure 2A and B). Fluorescein angiography showed leakage from neither the retinal vascular system nor the retinal pigment epithelium (RPE), although there was staining of the temporal peripapillary crescent (Figure 2C and D). There was hypofluorescence of the temporal peripapillary crescents (Figure 2E and F).