Ophtho On Call Case 5: Diagnosis & Conclusions

Diagnosis: Macula-On Rhegmatogenous Retinal Detachment 

Retinal detachment is the most common caxx 

 

The differential diagnosis Lincoff’s Rule xx: 

  • Anomalous optic discs: buried drusen, tilted disc, hypoplastic discs
  • Diabetic papillopathy
  • Hypertensive papillopathy
  • Intraocular or peri-ocular inflammation: posterior scleritis, perineuritis, uveitis with associated optic disc edema ( e.g. sarcoidosis, toxoplasmosis, and VKH), neuro-retinitis
  • compressive optic ne 

Lincoff's rule

Above Image Credit 

Treatment

Treatments are limited for this condition and there are no proven beneficial cures. The majority of patients keep vision they had at the onset of the event. The optic disc edema will resolve over time and the optic nerve will later demonstrate pallor in the affected areas.

Past trials attempted optic nerve decompression, intravitreal injections of bevacizumab, and triamcinolone with equivocal results. 

References and Additional Resources: 

1. “Retinoblastoma.” Available at: https://eyewiki.aao.org/Retinoblastoma#Differential_Diagnosis. 
2. Syed R, Ramasubramanian A,  Fekrat S, Scott IU. “A Stepwise Approach to Leukocoria.” Eyenet. July 2016. Available at: https://www.aao.org/eyenet/article/stepwise-approach-to-leukocoria.
3. Melamud A, Palekar R, Singh. “Retinoblastoma.American Family Physician. 2006;73(6):1039-1044.
4. Kaufman PL, Kim J, Berry JL. (2018). Retinoblastoma: Treatment and outcome. Payasse EA, Pappo AS, & Armsby C (Eds), UptoDate. Available at: https://www.uptodate.com/contents/retinoblastoma-treatment-and-outcome?search=retinoblastoma%20treatment&source=search_result&selectedTitle=1~82&usage_type=default&display_rank=1#H136152646.
5. Balmer A, Munier F. “Differential diagnosis of leukocoria and strabismus,  first presenting signs of retinoblastoma.” Clin Ophthalmol. 2007;1(4):431-439.
6. Correa ZM, Berry JL. “Review of Retinoblastoma.” April 2016. Available at: https://www.aao.org/disease-review/review-of-retinoblastoma.
7. Shields CL, Mashayekhi A, Cater J, et al. “Chemoreduction for Retinoblastoma: Analysis of Tumor Control and Risks for Recurrence in 457 Tumors.” Trans Am Ophthalmol Soc. 2004;102:35-45.
8. Pekacka A. The Role of Intraarterial Chemotherapy in the Management of Retinoblastoma. J Ophthalmol. 2020;2020:3638410.

Case 1 Index

Ophtho On Call Case 5 Index
Ophtho On Call Case 5: Introduction
Ophtho On Call Case 5 Additional History & Physical Exam
Ophtho On Call Case 5: Case Continued…