Fundus Flavimaculatus vs Multifocal Pattern Dystrophy: How to Differentiate

Optometry, Vol 82, No 6, June 2011

Poster 32

360

Fundus Flavimaculatus vs Multifocal Pattern Dystrophy:How to Differentiate

Jennifer Jones, O.D., Beth Sparrow, O.D., and John Sharpe,O.D., Southern College of Optometry, Memphis, Tennessee

Background: In 1962, Franceschetti introduced the term‘‘fundus flavimaculatus.’’ It is typically acquired as autosomalrecessive and presents in adulthood. Fundus flavimaculatus ischaracterized by bilateral, symmetric, yellow pisciform flecksat the level of the retinal pigment epithelium (RPE). Theseflecks are groups of enlarged RPE cells containing lipofuscinand they are typically scattered throughout the posterior pole.Macular dystrophy is not usually present in fundus flavima-culatus, therefore giving it a good visual prognosis. However,electroretinography (ERG) testing may show photopic abnor-malities. Multifocal pattern dystrophy is a key differential, asit presents with similar adult-onset findings, yet has anautosomal dominant inheritance. These patients typicallyhave good visual acuity and normal ERG results.Case Summary: A62-year-old black female presentedwith achief complaint of blur OU and a secondary complaint of dry,itchy eyes. Her medical history was positive for hypertensionand hepatitis B. Family ocular history was pertinent forstrabismus. Review of her ocular records revealed priordiagnoses of familial drusen and pattern dystrophyOU. Best-corrected visual acuities were +0.50 DS to 20/15 O.D. andplano DS to 20/20 O.S. with a +2.25 add. Amsler griddemonstrated metamorphopsia O.S. Anterior segment find-ings included mild superficial punctate keratitis OU andgrade 1 nuclear sclerosis and cortical cataracts OU. Dilatedfundus examination revealed multiple, yellow pisciformflecks around the macula OU with RPE disruptionO.S..O.D. Optical coherence tomography (OCT) demon-strated RPE deposits with normal macular thickness O.D.,O.S. ERG showed normal scotopic waves O.D., O.S. andreduced photopic A wave amplitudes O.D., O.S. consistentwith fundus flavimaculatus. This patient has been followedregularly for over 5 years with stable findings.Conclusion: This poster presents a rare and interestingclinical case with a taxing differential diagnosis. Serialfundus photography, OCT, and an ERG are included andwill highlight the differential process involved in managingthis case. This poster will compare and contrast fundusflavimaculatus with multifocal pattern dystrophy in order tooffer the optometrist a review on the proper diagnosis andmanagement of these patients.

Poster 33

A Cavernous Hemangioma as the Underlying Etiology forUnilateral Proptosis

Brooke Vegas, O.D., and Sylvia E. Sparrow, O.D.,University of Houston, Houston, Texas

Background: Cavernous hemangiomas are the most com-mon benign orbital tumors in adults. They usually manifest

during the third to fifth decades, with a higher predilectionfor women. While usually unilateral, rare bilateral caseshave been reported. A patient may complain of painless,progressive proptosis or have changes in refractive error,including inducement of hyperopia or reduction of myopiadue to the impinging mass. Associated morbidities arecompressive optic neuropathy, extraocular muscle dysfunc-tion, and cosmetic disfigurement.Case Report: A 34-year-old black male presented withcomplaints of blurred vision O.D. . O.S. for 3-6 monthsand his right eye ‘‘getting bigger’’ for about 5 years.Medical history was unremarkable. He took no medicationsand had no known drug allergies. His last eye examinationwas 1 year prior. Best visual acuities were 20/20 O.D. with+3.50-1.00 ! 080 and 20/20 O.S. with +0.25-1.00 ! 070.Pupils, eye movements, and confrontation visual fields werenormal. Hertel exophthalmometry was 26 O.D., 20 O.S.Non-contact tonometry measured 12 mmHg O.D. and 10mmHg O.S. Fundus examination revealed a C/D ratio of0.3 round OU with a blurred nasal margin O.D. and distinctmargins O.S. There were choroidal folds present in themacula of the O.D. All other structures were normal. Thepatient was referred to a retinal specialist where B-scanrevealed a mass surrounding the optic nerve in the right eyethat was impinging on the globe. A magnetic resonanceimaging (MRI) showed an intraconal lesion with lobulationthat was determined to be a cavernous hemangioma. Thepatient was therefore referred to an oculoplastics specialistfor removal of the lesion, and subsequent pathology reportconfirmed a cavernous hemangioma.Conclusion: While cavernous hemangiomas are the mostcommon orbital tumors in adults, there are several differ-ential diagnoses for proptotic conditions, including thyroideye disease, optic nerve head meningioma, and papille-dema. Due to the significant morbidity associated withthese conditions, the optometrist must be familiar with thevarying etiologies of proptosis. This poster will containfundus photography, external photography, MRI of the headand orbit and laboratory testing.

Poster 34

Lipemia Retinalis

Lynn Ueshiro, O.D., Spark Matsunaga Veterans AffairsMedical Center, Honolulu, Hawaii

Background: Lipemia retinalis is a rare condition thataffects the retinal vessels due to severely increased serumtriglycerides. It is asymptomatic so it does not affect vision.It can be found on routine dilated fundus exam (DFE).However, most cases will be discovered on patients hospi-talized for acute pancreatitis. It will resolve after triglycer-ides return below 2,500 mg/dL.Case Summary: A 40-year-old Hispanic diabetic malepatient presents for an eye exam. He plans to return to theArmy National Guard in a month in hopes of deployment toAfghanistan. He wants to know if he could be denied