Quick Case Challenge

A 46-year-old man with a history of well-controlled hypertension and hyperlipidemia presented for a televisit with his ophthalmologist, complaining of a “black dot” that suddenly appeared in the central vision of his right eye. He denied flashes, floaters, or a curtain-like visual disturbance. However, he did report recent systemic symptoms, including fatigue and muscle aches, over the past month.

He was advised to come in person for further evaluation, but he was not feeling well and lives 50 miles from the ophthalmologist’s office. He was not able to come in for another week. When he got to the clinic, his visual acuity was 20/80 in the right eye and 20/20 in the left eye. The anterior segment exam was unremarkable. On dilated fundus exam of the right eye, the physician observed:
• Mild optic disc edema
• Extensive intraretinal hemorrhages in the macula
• Cotton wool spots and hemorrhages in all four quadrants
• Marked venous tortuosity

Optical coherence tomography (OCT) confirmed intraretinal fluid, and fluorescein angiography revealed diffuse venous leakage and peripheral capillary nonperfusion. The left eye was normal. He underwent COVID-19 antibody testing, which returned positive.


















References

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  • Miller CG, Kim BJ. Central Retinal Vein Occlusion in a 46-Year-Old Man with COVID-19: Case Report and Review of the Literature. Case Rep Ophthalmol. 2021;12(2):646-652. Published 2021 Jul 19. doi:10.1159/000517417
  • Chaudhury AS, Ige M, Marwah S, et al. Race, Social Determinants of Health, and the Quality of Diabetic Eye Care. JAMA Ophthalmol. 2024;142(10):961-970. doi:10.1001/jamaophthalmol.2024.3528
  • Danzig CJ, Dinah C, Ghanchi F, et al. Faricimab Treat-and-Extend Dosing for Macular Edema Due to Retinal Vein Occlusion: 72-Week Results from the BALATON and COMINO Trials. Ophthalmol Retina. Published online March 17, 2025. doi:10.1016/j.oret.2025.03.005
  • Brown DM, Boyer DS, Do DV, et al. Intravitreal aflibercept 8 mg in diabetic macular oedema (PHOTON): 48-week results from a randomised, double-masked, non-inferiority, phase 2/3 trial. Lancet. 2024;403(10432):1153-1163. doi:10.1016/S0140-6736(23)02577-1