VCOM Louisiana Research Day Program Book 2024

Case Studies

Jacob Morgan, BS; Briana Krutsinger, BS; Levent Akduman, MD VCOM-Louisiana 49 HEAVY HARD EXUDATES IN THE FOVEA ARE NOT ALWAYS ASSOCIATED WITH A BAD VISUAL OUTCOME: A CASE REPORT

Background: Lipid exudates are hard pockets of lipoproteins and lipids within the retina after some vascular insult. Classically, these heavy hard exudates are associated with poor long term visual outcome even after resolution with treatment. Here, we report an unexpected, favorable outcome in an eye with a dense hard exudate involving the fovea who recovered significant vision and resolution of exudates after treatment. Objective: Heavy hard exudates are not always associated with poor visual prognosis. The goal of this report is to demonstrate that hard exudates may have a variable effect on long term vision. Furthermore, we conclude that every measure should be utilized in assessment and treatment to maximize the long term visual potential following resolution. Methods: A sixty-two-year-old female presented with a dense hard exudate in the fovea secondary to a retinal arteriolar macroaneurysm. Initial and final best corrected visual acuity (BCVA), fundus photo and fluorescein angiogram and OCTs were obtained. The patient was treated with argon laser photocoagulation in her right eye 8 months prior to onset. Additional laser treatment was done at onset. Throughout the patient’s course, she was

observed with OCT and dilated fundus exams (DFE). Results: Results: With gradual resolution of the exudates after the treatment, there was a stark improvement in the patient’s visual acuity which changed from 20/400 to 20/70 over the period of 29 months. Architecture of the retina went from a dense scattering of hyperreflective, hard exudates at onset to clear distinct layers of the retina as seen prior to onset. Conclusions: Conclusion: Despite the fact that most cases of heavy hard foveal exudates do poorly after treatment, some eyes may do remarkably better. Factors predictive of a better outcome need to be studied more and every effort should be utilized for a quick resolution of the hard exudates in the fovea. Furthermore, treatment and correction should be completed to not miss any opportunity for an eye to gain a functional vision following resolution.

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