91. VA loss after eye injection
An 85-year-old loses vision after an eye injection. Why?
For the most part, the inner retina appears to be within normal limits, as the nerve fiber layer (NFL) down to the outer nuclear layer (ONL) has normal architecture. To the left of the image, there is normal intact retinal pigment epithelium (RPE). In the middle of the image, the RPE is thickened and elevated. It is associated with significant hyperreflectivity. This is because it is associated with a choroidal neovascularization (CNV). This complex is causing some shadowing of the deep tissue.
To the right, the RPE is absent and Bruch's membrane is visible. With the loss of the RPE there is increased hyperreflectivity of the deeper tissues; a reverse shadow is present. This person has an elevated fibrovascular epithelial detachment (PED) which tore following injection; the diagnosis is compatible with an RPE rip.
An RPE rip can occur spontaneously, or post injection, laser or photodynamic therapy.
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