Take-home: Knowledge of pathologic patterns is necessary in medical retina, especially patterns that are unusual or rare.
Pattern recognition skills are essential in medical retina. Lawrence Yannuzzi, MD, highlights four patterns that he believes are relevant in clinical practice and should be recognized–and not missed–by retinal specialists. The four patterns are:
‘Chrysanthemum’ in multifocal choroiditis
Multifocal choroiditis is a chronic, progressive, bilateral inflammatory chorioretinopathy that affects healthy, myopic white women and is not associated with any systemic or ocular diseases. Affected eyes have multiple punched-out chorioretinal lesions, peripapillary atrophy, and curvilinear chorioretinal streaks in the periphery.
These eyes are at high risk of secondary choroidal neovascularization (CNV), according to Dr. Yannuzzi. Dr. Yannuzzi is vice chairman and director of the LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, and founder of Vitreous Retina Macula Consultants of New York.
Dr. Yannuzzi described the case of a 37-year-old woman who presented with acute visual loss in her left eye. On clinical examination, three concentric areas consistent with an old fibrous scar, more recent proliferation, and a fresh bleeding membrane were observed. Spots and chrysanthemum lesions were visible in the periphery.
Chrysanthemum lesions are solid with curly edges circumferentially that stain with fluorescein angiography (FA). Indocyanine green angiography (ICGA), while not necessary for diagnosis, accentuates the number and density of the spots.
Optical coherence tomography (OCT) of the lesion shows some hyper-reflectivity underneath the retinal pigment epithelium (RPE), although as the disease is choroidal in nature, it does involve the RPE. This patient was observed.