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Symptoms to Diagnosis

Central vision loss in a 44-year-old woman

Walker M. Schmidt, BS, Nirosha D. Perera, MD, Blake H. Fortes, MD, Benjamin A. Nelson, MD, Wendy M. Smith, MD and Hannah C. Nordhues, MD
Cleveland Clinic Journal of Medicine January 2023, 90 (1) 35-41; DOI: https://doi.org/10.3949/ccjm.90a.22038
Walker M. Schmidt
Medical Student, Alix School of Medicine, Mayo Clinic, Rochester, MN
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  • For correspondence: [email protected]
Nirosha D. Perera
Resident Physician, Department of Medicine, Mayo Clinic, Rochester, MN
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Blake H. Fortes
Resident Physician, Department of Ophthalmology, Mayo Clinic, Rochester, MN
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Benjamin A. Nelson
Resident Physician, Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD
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Wendy M. Smith
Associate Professor, Department of Ophthalmology, Mayo Clinic, Rochester, MN
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Hannah C. Nordhues
Assistant Professor, Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
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    Figure 1

    (A) Near infrared reflectance and (B) corresponding macula optical coherence tomography of the left eye, derived from the green line in image (A), demonstrate subretinal infiltrates (white arrow) and increased choroidal hypertransmission (white bracket) due to outer retinal atrophy. Vitritis is shown with a white asterisk.

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    Figure 2

    Fundus autofluorescence of right and left eye. (A) In the right eye, there is a placoid appearance in the macula (white arrow). (B) In the left eye, there is a stippled pattern of hyperautofluorescence and hypoautofluorescence scattered throughout the macula (white arrow). (C) Fluorescein angiography and (D) indocyanine green angiography of the right eye demonstrate a stippled pattern of hyperfluorescence with regions of hypofluorescence owing to blocking consistent with the location of the subretinal infiltrates (white arrow in C; similar finding in D). Just inferior to the inferior vascular arcade, there is a band of perivascular hyperfluorescence consistent with perivascular staining (white bracket).

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    TABLE 1

    Uveitis

    LocationStructuresPossible etiology
    Anterior uveitisIris, ciliary body, anterior chamberSarcoidosis, ankylosing spondylitis, inflammatory bowel disease, Lyme disease, syphilis
    Intermediate uveitisVitreous, peripheral retinaTuberculosis, multiple sclerosis, sarcoidosis, inflammatory bowel disease, Lyme disease, syphilis
    Posterior uveitisRetina, choroidToxoplasmosis, tuberculosis, herpes simplex virus, varicella zoster virus, Lyme disease, syphilis
    PanuveitisAll of the aboveSarcoidosis, sympathetic ophthalmia, ocular or hematologic neoplasm, tuberculosis, Behcet disease, Lyme disease, syphilis
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In this issue

Cleveland Clinic Journal of Medicine: 90 (1)
Cleveland Clinic Journal of Medicine
Vol. 90, Issue 1
1 Jan 2023
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Central vision loss in a 44-year-old woman
Walker M. Schmidt, Nirosha D. Perera, Blake H. Fortes, Benjamin A. Nelson, Wendy M. Smith, Hannah C. Nordhues
Cleveland Clinic Journal of Medicine Jan 2023, 90 (1) 35-41; DOI: 10.3949/ccjm.90a.22038

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Central vision loss in a 44-year-old woman
Walker M. Schmidt, Nirosha D. Perera, Blake H. Fortes, Benjamin A. Nelson, Wendy M. Smith, Hannah C. Nordhues
Cleveland Clinic Journal of Medicine Jan 2023, 90 (1) 35-41; DOI: 10.3949/ccjm.90a.22038
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