(scroll through images horizontally and click on link on bottom left of image for the diagnosis)

Note the aneurysms with dilation of involved vessels and surrounding exudation with fluid and lipid deposits in the retinal periphery.  Fine telangiectatic vessels (not to be confused with neovascularisation) are also present, albeit subtle.

Note the emanation of the pigmented lesion from the optic nerve head onto the retina without any appreciable elevation or distortion of the native structures.  No surrounding fluid or hemorrhage is appreciated to suggest choroidal neovascularization.  A halo of depigmentation is noted which is rare.  This lesion is benign.

A benign peripheral chorioretinal degeneration also referred to as cobblestone degeneration.  Located anywhere between the ora and the equator.  Does not predispose to a retinal detachment.

An autosomal dominant condition with variable presentation and visual acuity.  Although visual acuity is variable, it typically doesn't worsen further by the time the condition is diagnosed.  Bilateral.

Not to be confused with a horseshoe tear or an atrophic hole , this is a congenital peripheral lesion which has been noted in 5% of the general population.  Although there is a slightly higher risk of retinal detachment with this lesion, it is less than that of an atrophic hole or a horseshoe tear when it is asymptomatic.  As a result, some recommend simple observation without any prophylactic intervention.  In this image, a patch of lattice is noted anterior to the tuft. 

Hyperreflective material symmetrically accumulated in a rounded pattern underneath the fovea.  Note absence of any overlying fluid or surrounding retinal edema.  Such a finding can present either congenitally early in life, or acquired in the 40's or 50's.  In any case, no treatment is required.

More than just simple vitreomacular adhesion, this OCT shows distortion of the retinal layers caused by antero-posterior traction from the posterior hyaloid face.  Note that the outer retinal layers are intact.

Flat, well-delineated oval lesion.  Benign, with malignant transformation possible but extremely rare.  Usually unilateral.  Association with Familial Adenomatous Polyposis (and hence, colon cancer) is with bilateral lesions that tend to be smaller with a more irregular border.

Congenital defect with variable visual acuity.  Yearly monitoring needed to follow for retinal detachment which is noted with greater prevlance in this condition.  If bilateral, screening should be carried out by primary care for other systemic abnormalities.

Classic OCT appearance of focal symmetric rounded collection of subretinal fluid with distinct edges of retinal reapportion (to help differentiate from frank retinal detachment).  Treatment options are guided by duration, visual symptoms and their impact on daily functioning.

Using the caliber of the retinal venule at the edge of the optic disc as a guide, all of the drusen present here are small in size.  This is not age related macular degeneration and the standard AREDS2 formula is not indicated as a therapeutic measure.

The hyperreflective white line above the retinal surface is the inner surface of the epiretinal membrane.  The vertical green marker indicates the normal location of the foveal center.  The foveal tissue to the left of the marker has been displaced laterally to the left by the tractional forces of the epiretinal membrane, thereby opening up the lamellar macular hole.  Similar tractional forces are displayed to the right of the green line, but the foveal tissue there has been pulled "up" more.  Vitrectomy with membrane peel and air fill is a highly successful means of restoring normal foveal anatomy.  Whether to pursue such a treatment depends on the patient's symptoms and health of the underlying tissues.

The vertical pink marker indicates the normal location of the foveal center.  A classic appearance of a full thickness macular hole.  Cystic retinal changes are noted within the cuff of the retinal hole.  Although elective, surgical repair has a high success rate, with exceptions for very chronic, large, or atrophic holes which tend to have poorer visual recovery.  More and more, retina surgeons are finding that face down positioning during the postoperative recovery period may be reduced or even eliminated in most circumstances.

The epiretinal membrane is distinguished by the thick solid hyperreflective white signal on the inner surface of the retina.  The lateral traction from the epiretinal membrane is causing the corrugation in the inner retinal surface, which would be noted as striae on direct examination.  A small lamellar macular hole is noted, with the central foveal tissue being symmetrically laterally displaced producing an inner retinal cavitation.  Below that is a focal area of subretinal fluid which is likely "spillover" from the very prominent diffuse cystoid edema in the outer retinal layers.  The management of this patient involved excluding inflammatory and choroidal neovascular etiologies in a stepwise manner.  After doing so, vitrectomy with membrane peel was performed, leading to vision improvement and restoration of the normal retinal microarchitecture.

The choroidal neovascular membrane is visualized as a mound extending from the choroid breaking into the subretinal space and disrupting the normal architecture of the overlying retinal.  Associated subretinal fluid and retinal thickening can also be appreciated.  Signs of the patient's history of histoplasmosis were recognized on direct examination.  CNV associated with POHS tends to have a prominent subretinal component.

A somewhat large horseshoe tear, not to be mistakenly confused with a giant retinal tear, is the causative break for this rhegmatogenous retinal detachment which has an obvious bullous component near the tear, as well as a shallow component involving the the entire macula.  The patient experienced full recovery of vision after successful repair in the office with pneumatic retinopexy.

The view is hazy from the chronic vitreous hemorrhage caused by the diabetic fibrovascular proliferation.  Fortunately, the use of timely anti-VEGF injections and panretinal photocoagulation can help many such eyes avoid a trip to the operating room for surgical intervention.

This peripheral atrophic hole is on the larger end of the spectrum of atrophic holes that are seen in routine practice.  Retinal detachment prophylaxis with laser treatment was recommended.  The decision to treat an atrophic retinal hole with prophylactic laser is debatable and is ideally made on a case by case basis.

More cases accessible on a separate webpage by selecting the horizontally arranged images at the top of this webpage (starting with Case #19)