Case Presentation

A 71-year-old female patient with a history of nonexudative age-related macular degeneration (AMD) was referred for evaluation of a submacular hemorrhage in the left eye. Due to the extent of the hemorrhage, her visual acuity was HM. The referring doctor proceeded with an intravitreal injection of bevacizumab but desired a second opinion to rule out a choroidal mass.

Upon examining the patient, sub-retinal blood within the macula was noted with what appeared to be nodular elevation. Differential diagnosis included retinal arterial macroaneurysm, choroidal mass, or large retinal pigment epithelial detachment (PED). The patient was imaged with the new Silverstone RGB (Optos), a retinal imaging device that integrates true color red-green-blue (RGB) optomap imaging (ultra-widefield [UWF™]  retinal imaging) with navigated swept-source optical coherence tomography (SS-OCT), to further investigate and rule out a choroidal mass.

Image Findings

The optomap RGB image captured the extent of the multi-layered hemorrhage extending through the inferotemporal arcade with the true color improving visualization of this complex exudation. Imaging through hemorrhaging and media opacity can be challenging, with ultrasound being the traditional diagnostic tool but requiring specialized clinic resources, time, and patient cooperation. In these cases, Silverstone RGB with UWF and SS-OCT technology allows for efficient, high-resolution, noninvasive, navigable multimodal imaging anywhere on the 200° optomap image. The initial concerns related to nodular elevation from a choroidal mass were relieved with a single 23-mm SS-OCT extended line scan providing the length, depth, and resolution necessary to image through the dense subretinal blood and examine the full extent of the lesion. SS-OCT revealed only subretinal hemorrhage with large PED. Optos UWF angiography showed no evidence of internal circulation or vascular abnormalities characteristic of a choroidal tumor.

Multimodal Optos imaging allowed for quick, easy diagnosis and altered the clinical management of this patient, confirming exudative AMD with active choroidal neovascularization.

Janelle F. Adeniran, MD, specializes in the medical and surgical management of diabetic retinopathy, macular degeneration, retinal detachment, ocular trauma, and ocular tumors. She is a co-curator for Retina Rocks, the world’s largest online multimedia retina image library and bibliography repository.

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