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MACULA EDEMA with SCOTOMA. RETINITIS PIGMENTOSA, GLAUCOMA?

Resolved Question:

Dear Doctor,

(Note: some of your doctors might recognize this problem. I have consulted other websites. I am seeking another opinion).

Nine years ago an optometrist found a nevus on my left retina and two years ago it began leaking fluid. Edema invaded my macula causing wavy vision. Edema advanced (from nasal side—my point of view) and retreated a few times. I could easily see how advanced by looking at a plain background and blinking. This has corresponded to images taken by my optical oncologist. The last time it advanced a scotoma appeared (about seven months ago). It is clear (not black) and absolute. The temporal boarder of the scotoma matches exactly the last farthest extent of the edema. The edema has retreated (based on December 8, 2014 fluorescein angiography and OCT) and the scotoma remains. No images taken by the doctor reflect the scotoma. It is C-shaped (correct C, not backwards), bent around the fovea, extending 2-5 lines on the amsler grid. The ocular oncologist says it has to be a result of the edema and I agree. He says he has never heard of anything like it. Days of internet research, mostly professional articles, revealed no explanation. There are many scotomas that match mine (crescent-shaped) but they are associated with brain tumors, glaucoma, retinitis pigmentosa, or other pathologies, never edema resulting from nevi.

I am 53 years old, male, healthy, with no family history of cancer or any eye disease. I wear contact lenses for myopia. Besides myopia, my right eye is perfectly healthy.

The nevus has not grown since its discovery and is not large enough to warrant immediate treatment for melanoma. This eye might be radiated someday, but it might not, and I want to know if this scotoma can be treated. In the affected eye I have 20/40 vision (with corrective lens) in an area about the size of a dime held at arm’s length, surrounded on three sides by the scotoma (through which I am completely blind). Peripheral vision outside the scotoma is good.

Thank you very much.


Category: Ophthalmologist

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Category: Ophthalmologist
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Expert:  Dr. Manish Malhotra replied 4 Days ago

Hello,
Thank you for posting your query at DoctorSpring.com
The scotomas can never be treated, as these may get reduced in size , or increase in size depending upon the activity of disease.
You need to consult a retina specialist, in order to see, if it could be treated by giving Injection Avastin.
Feel free to discuss further,

Dr Manish Malhotra
Consultant Eye Surgeon


Patient replied :

Considering the details I gave (the disease, edema, is gone, etc.), do you think the scotoma will go away?


Expert:  Dr. Manish Malhotra replied 3 Days ago

Dear Sir,
Scotomas are like ghosts, if the odema goes away it leaves a crumpled retina , which produces a wavy or distorted picture, so to be more precise , the scotomas can reduce in size but not vanish , & increase once activity returns.
Regards


Patient replied :

The edema has gone away and I don’t have distortion, I have blindness (at the scotoma). I feel the symptoms should be improving because the edema is gone. Have you seen this before or heard of it, or have you read about it in the literature? (That is, edema retreating and leaving a scotoma). If so, what happened? Did it go away at least partially? If so, how long did it take?
Thanks.


Expert:  Dr. Manish Malhotra replied 2 Days ago

Scotomas can be of variable size , which might go completely / partially.
Till now, I have come across a few cases, and in most of them it had gone partially but not completely.
It's variable nature can really never be predicted unfortunately.
Regards.


Dr. Manish Malhotra
Category: Ophthalmologist
Experience: 
Fellowship: L. V. Prasad Eye Institute, Hyderabad
Fellow Pediatric Ophthalmology & Squint (L.V. Prasad Eye Institute, Hyderabad)
Medical School, Residency: MBBS, DOMS, FLVPEI, Nagpur university, 1995
Dr. Manish Malhotra and 4 other Medical Specialists are ready to help you

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