Unilateral Disease with Vitreomacular Traction Syndrome

A 41 year old Asian male presented to his optometrist for his annual eye examination. The optometrist carried out a dilated retinal examination in both eyes and immediately noted an anomalous pattern in the left inferior retina. The visual acuity measured 20/20. The patient was referred to South Bay Retina for evaluation.

Exam: Benign anterior segment with normal intraocular pressures. There was no history of systemic disease in the patient though family history is notable for hypertension.

Retinal examination: The left eye was notable for an exudative reaction in the inferior retina with yellowish exudates and a reticulated hyperpigmentation of the surrounding RPE. No macular edema was detected. A fundus photo is shown and demonstrates the findings of an exudative reaction with deposits and even an early tractional elevation of the retina. The right eye retina was completely normal with healthy pink and orange retina throughout. The photos of the left retina are shown below.

An angiogram was carried out and showed several areas of perivascular dye leakage in the inferior retina. The patient was asked to return for treatment on a subsequent day.

Upon completion of the exam, Dr. Narain concluded that the patient will need pneumatic retinopexy or PRP laser some time in the future. No treatment was administered.

Five days later, the patient returned to the office complaining that his dilation with tropicamide 1% and neosynephrine 2.5% did not recover after the drops. Suspecting that he had possibly received a longer acting medicine, Dr. Narain rechecked the patient’s eyes and noted that the pupil was in fact normal. What was not normal was the surface of the retina. Dr. Narain requested an OCT. With the OCT scanner, particularly the Spectral Domain OCT scanner, the following image was obtained:

The OCT showed concurrent vitreomacular traction syndrome. Dr. Narain recommended that the patient receive retinal tear laser. Patient received RT laser OS and scheduled for a two week follow-up.

Two weeks later patient returned to the office. Vitals were normal and VA = 20/20-2 OS. Upon completing clinical exams, Dr. Narain found vascular leakage in the inferior retina. Immediately, PRP laser was administered in the patient’s left eye. Patient was prescribed Alrex and was scheduled for a 4 weeks follow-up.

Question: What is the diagnosis?