Retina Service Department of Ophthalmology HC FCM UNICAMP Multifocal coroidopathy an unusual case Clinical presentation April 2019 Initial Presentation Male 70y Chronic and progressive visual acuity reduction in both eyes with recent ID: 1000161
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1. Vicente Hidalgo FernandesRetina Service –Department of OphthalmologyHC – FCM - UNICAMPMultifocal coroidopathyan unusual case
2. Clinical presentationApril 2019 Initial PresentationMale, 70yChronic and progressive visual acuity reduction in both eyes, with recent worseningNo previous eye surgery or trauma
3. Clinical presentationApril 2019 - Physical examinationBCVA0,15 // CFBiomicroscopyAnterior chamber formed, no evidence of inflammationPhakic, cataract N1IOP14mmHg both eyes
4. Clinical presentationFundoscopy
5. Medical history2016 / 2017Difficult to control hypertension - Uses four classes of medicationsLower limb edemaLaboratory testsProteinuria 24h 5,24g/24h (RV < 150)Urine analysisProt 3+ / Hem 2+ c/ DE Albumin / Creatine3904,25mg/g (RV < 30) Creatine1,57 mg/dL (VR < 1,3)Nephrotic Syndrome - Undetermined etiology
6. Medical history2016 / 2017Ophthalmological assessment at the timeBCVA: 0,4 both eyesBIO: normal Fundoscopy: DrusesHypothesis: Non-exsudative AMD
7. Medical history2016 / 2017Etiology investigationSyphilis - VDRLNRSchistosomiasisSyphilis – FTA-ABSReagentXistoimuneReagentC3 e C4ReducedXistoseNRRenal biopsy: Type I Membranoproliferative GlomerulonephritisHypothesis: MPGN I secondary to Schistosomiasis
8. Medical history2018/2019Edema decompensation AnasarcaCorticosteroid - Prednisone 80mg/d15 days Ceased due to side effectsNo record of hypertensive peaks at the time
9. complementary examsfundus autofluorescence
10. complementary examsFluorescein Angiography21 s43 s1:44 s
11. complementary examsFluorescein Angiography1:12 s1:35 s
12. complementary examsIndocyanine green angiography16 s25 s
13. complementary examsIndocyanine green angiography1:06 s1:58 s
14. complementary examsoptical coherence tomography
15. complementary examsoptical coherence tomography
16. complementary examsoptical coherence tomography
17. complementary examsoptical coherence tomography
18. complementary examsoCT – angiography – Right Eye
19. complementary examsoCT – angiography – left eye
20. DiscussionMultifocal central serous chorioretinopathy?Schistosomiasis-related multifocal choroidopathy?Polypoidal choroidal vasculopathy?Hypertensive choroidopathy?