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Retina Rocks

@retina.rocks

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Free 49,000+ file retina image bank catalogued by disease state. Highlights over 13,500 critical journal articles for additional education.
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Our Optos fans say their love for Retina Rocks is wide-field 😮‍💨♥️ #diehardretinarocksfans by @retina.rocks
1
6 hours ago
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Traumatic giant macular tear A Hole Lot of Trauma Today’s European VitreoRetinal Society (EVRS) case of the week (@evrsimagebank) was submitted by Hande Güçlü (@ophthagram.thrace). This 30YO male presented with persistent decreased vision in his left eye two months following blunt ocular trauma. While incarcerated, he sustained blunt head and ocular trauma during a physical assault resulting in his head striking a bunk bed. Vision was counting fingers OS. Fundus photography shows a diamond-shaped giant macular tear. Following vitrectomy, internal limiting membrane peeling, and silicone oil, vision improved to 20/200 with a residual open macular hole. Go to www.retinarocks.org/cases for more macular hole and RRD cases. [This case can be found on www.retinarocks.org in the Image Gallery, Macular hole folder Macular hole SZH-20180214] Have an interesting case and want to help your peers learn something about the retina? Submit your images at www.retinarocks.org. Retina Rocks and its charitable foundation, "Eye Reach" are supported in part by Topcon Healthcare (@topconhealthcare). Retina Rocks is the image bank for the Retina World Congress (@RetinaWorldCongress). #macularhole #retinaldetachment #trauma #retina #optometry #ophthalmology #cool #odsonfacebook #TopconHealthcare #adarshcharitablefoundation by @retina.rocks
9
2 days ago
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Thorn intraocular foreign body Defying anatomical boundaries Today’s case was submitted by Ayushi Gupta (@ayushigupta011) and Vishal Agrawal (@vishal.agrawal.5), Agrawal Hospital Jaipur. This 28YO male presented 5-6 hours following a perforating thorn injury to his left eye. He was standing in an open moving loading vehicle when an Acacia tree branch suddenly hit his eye. Vision was 20/20 in his normal OD and 20/40 OS. External examination showed a thorn lodged in the inferonasal sclera (image 1). There were moderate anterior chamber cells on slit lamp examination with a fibrinous pupillary membrane. Fundus examination revealed vascular sheathing predominantly in the nasal quadrant, multiple white-centered retinal hemorrhages, and vitreous exudates. The thorn penetrated the retina and extended into the vitreous cavity (arrow). Despite being taken to surgery approximately two hours later, intraoperatively there was a dramatic increase in vascular sheathing extending into the macula (image 2). Pars plana vitrectomy was performed with removal of the thorn foreign body, repair of the scleral laceration, cryotherapy and endolaser photocoagulation surrounding the retinal break, silicone oil tamponade, and injection of intravitreal antibiotics. The thorn measured approximately 15mm. On the first postoperative day, the posterior segment appeared healthy with resolved vascular sheathing. One week postop, vision was 20/50 with a +5-diopter sphere, the retina remained completely attached, and good laser scarring was noted around the penetration site (image 3). A small laser scar is also noted inferiorly to an area suspect for a possible break that was photocoagulated intraoperatively Go to www.retinarocks.org/cases for more intraocular foreign body cases. [This case can be found on www.retinarocks.org in the Image Gallery, Intraocular foreign body (IOFB) + Siderosis folder, IOFB HFM-] Have an interesting case and want to help your peers learn something about the retina? Submit your images at www.retinarocks.org. Keep reading in the comments above 👆👆👆 by @retina.rocks
3
3 days ago
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Placoid and multifocal tubercular chorioretinitis Tuberculosis: Retina Edition This 70YO female with a history of Type 2 diabetes presented with 2 weeks of vision loss in her right eye. Vision was counting fingers OS and 20/30 OS. Optos color RGB imaging of her right eye shows a whitish placoid subretinal macular and peripapillary lesion with nerve swelling and peripapillary hemorrhages (image 3). There are multifocal macular and peripapillary scars OS with overlying orange pigment and radiating nasal macular lipid. Fundus autofluorescence (FAF) shows hyper-FAF of the placoid lesion OD and variable hyper- and hypo-FAF from the multifocal lesions OS. Triton swept-source OCT OD (image 1) shows areas of hyperreflective subretinal vs outer retinal hyperreflective material more superiorly (yellow line/box/arrow) and a large bacillary layer detachment more inferiorly (red line/box/asterisk). OCT scanning OS shows variable ellipsoid zone disruption with hyperreflective nasal lipid flecks in the outer plexiform and inner and outer nuclear layers (image 2). QuantiFERON-TB testing was positive, and chest X-ray revealed a mass-like opacity in the posterior right upper lobe. She was referred to infectious disease and started on anti-tuberculosis treatment (ATT). Although tuberculosis (TB) most commonly presents with pulmonary involvement, extrapulmonary sites can include the gastrointestinal, skin, cardiovascular, genitourinary, and central nervous systems, including the eyes. Ocular involvement, like syphilis, can mimic virtually any type of uveitis, including anterior, intermediate, posterior, and panuveitis, retinitis and retinal vasculitis, neuroretinitis, optic neuropathy, choroidal granuloma (our patient), choroiditis, and scleritis. For an excellent review of intraocular tuberculosis, see Bupta et al, Survey Ophthalmology 2007;52:561-587. The funduscopic, FAF, and OCT findings dramatically improved after 4 weeks of ATT (image 4). Vision improved to 20/25 OU. We continue to follow her closely. Go to www.retinarocks.org/cases for more TB cases. Keep reading in the comments above 👆👆👆 by @retina.rocks
4
4 days ago
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Bardet-Biedl Syndrome The Cilia Missed the Memo Today’s case was submitted by João Pedro Marques (@retinaldystrophies, Coimbra University Hospital). This 51YO male has a history of intellectual developmental disorder, arterial hypertension, polydactyly of his right hand (surgery as a child) and foot. He has complained of poor vision, photophobia, and dyschromatopsia since childhood. Vision was 20/400 OU. Optos color RG imaging of his right eye shows faint foveal pigmentary changes. These are more prominent on fundus autofluorescence (FAF), which shows increased foveal hyper-FAF with a surrounding ring of hyper-FAF. OCT scanning shows variable thinning of the outer retina and RPE centrally. Identical findings were noted in his left eye (not shown). A sixth toe is noted on his right foot (arrow). Bardet-Biedl Syndrome (BBS) is a rare autosomal recessive ciliopathy causing multisystem disease via primary cilia dysfunction (Shoemaker, Diabetes Obes 2024;26(Suppl. 2):25-33). Diagnosis is clinical, requiring four primary features (or three primary plus two secondary): rod-cone dystrophy, obesity, polydactyly, hypogonadism, renal anomalies, and learning disability. The defining ocular finding is progressive rod-cone dystrophy, with early night blindness, peripheral field loss, and macular involvement, accompanied by vascular attenuation, disc pallor, abnormal ERG, and blindness by early adulthood. Our patient’s genetic testing revealed that he was homozygous for the pathogenic variant c.1169T>G p.(Met390Arg) in the BBS1 gene. Continued observation was recommended. Go to www.retinarocks.org/cases for more cases. [This case can be found on www.retinarocks.org in the Image Gallery, Retinitis pigmentosa (RP) + Misc Inherited retinal disorders (IRD) folder, Bardet-Biedl YVM-20260705] Have an interesting case and want to help your peers learn something about the retina? Submit your images at www.retinarocks.org. Retina Rocks is the image bank for the Retina World Congress (@RetinaWorldCongress). #bardetbiedl #retina #optometry #ophthalmology #cool #odsonfacebook #TopconHealthcare #adarshcharitablefoundation by @retina.rocks
1
5 days ago
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Choroidal rupture Tennis, Anyone? Today’s case was submitted by Abhishek Karra (@theeyecasebook) and Ravindra Karra (@ravindrakarra). This 16YO male presented with acute vision loss in his left eye 3 days earlier following blunt trauma from a tennis ball. Vision was counting fingers. Fundus photography (image 1) shows diffuse thin subretinal blood with multiple choroidal ruptures (arrows). Observation was recommended. Vision improved to 20/200 at 6 weeks, with resolution of all blood (image 2). There are mild granular pigmentary changes in the central macula. An acute submacular hemorrhage following blunt trauma almost always indicates an underlying choroidal rupture. As the blood clears, the rupture appears as a curvilinear or crescent-shaped yellowish-white lesion. It occurs due to rapid compression-expansion stress on Bruch's membrane, which is less elastic and has less tensile strength than the sclera, leading to its fracture. The final vision is usually good unless the rupture extends through the macular center. These patients need to be followed long-term due to the increased risk of macular neovascularization. Go to www.retinarocks.org/cases for more choroidal rupture cases. [This case can be found on www.retinarocks.org in the Image Gallery, Choroidal rupture folder, Choroidal rupture ZIL-] Have an interesting case and want to help your peers learn something about the retina? Submit your images at www.retinarocks.org. Retina Rocks is the image bank for the Retina World Congress (@RetinaWorldCongress). #choroidalrupture #retina #optometry #ophthalmology #cool #odsonfacebook #TopconHealthcare #adarshcharitablefoundation by @retina.rocks
0
6 days ago
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Do you want to be as smart as Dr. Johnson??? by @retina.rocks
5
8 days ago
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Central retinal artery occlusion from mucormycosis Fungus Among Us Today’s European VitreoRetinal Society (EVRS) case of the week (@evrsimagebank) was submitted by Kanwaljeet Harjot Madan (@drkhmadan). This 32YO diabetic male presented with profound vision loss following rhino-orbital-cerebral mucormycosis, for which he had undergone orbital exenteration 8 months earlier. Vision was no light perception with a fixed and mid-dilated pupil. Color photography shows a pale nerve with blood on and surrounding the disc, with a striking narrow white vascular tree. OCT angiography shows virtually no flow signals in the thinned, atrophic, hyperreflective inner and mid-retinal layers. Mucormycosis is an angioinvasive fungal infection, most often affecting patients with poorly controlled diabetes (especially ketoacidosis), immunosuppression, or iron overload (Kontoyiannis et al, NEJM 2026;394:684-698). Its hallmark is hyphal invasion of vessel walls, producing thrombosis and ischemic necrosis. In the rhino-orbital-cerebral form, the fungus seeds the sinuses and spreads to the orbit, ophthalmic artery, and optic nerve, with intracranial extension via the cavernous sinus. Direct fungal infiltration of the central retinal artery can result in devastating retinal ischemia, and combined retinal and optic nerve infarction may cause irreversible vision loss. CRAO may also herald further life-threatening vascular complications, including stroke, arising from hyphal luminal growth, endothelial injury, and vasculitis (Kamath et al, Indian J Ophthalmol 2023;71:2904-2906). These events often occur despite anticoagulation and carry high mortality, underscoring the need for urgent liposomal amphotericin B and surgical debridement. Go to www.retinarocks.org/cases for more cases. [This case can be found on www.retinarocks.org in the Image Library, Mucormycosis folder, Mucormycosis NVI-20260626] Have an interesting case and want to help your peers learn something about the retina? Submit your images at www.retinarocks.org. by @retina.rocks
1
9 days ago
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Bilateral torpedo maculopathy Today’s case was submitted by Mattie Adams (@mattie_monroe_adams). This 10YO boy was referred for asymptomatic retinal lesions. He was adopted so the family history was unknown. The patient and guardian reported a longstanding history of persistent diarrhea that at times required hospitalization. Vision was 20/20 bilaterally. Color photography shows bilateral torpedo-shaped areas of depigmentation in each superotemporal macula (images 1 and 2). The lesions were hypo-autofluorescent (not shown). OCT scanning shows outer retinal atrophy through each lesion. Torpedo maculopathy was originally described by Gass as a solitary hypopigmented nevus of the RPE (Arch Ophthalmology 1992;110:1358-1359). These benign lesions are teardrop shaped and are almost always located in the horizontal meridian in the temporal macula. Vision is almost always normal. There is a small risk for macular neovascularization. The lesions are virtually always unilateral, and we could find only a single case report of bilateral lesions on a PubMed search (Richez et al, J Fr Ophthalmol 2010;33:296). Given our patient’s GI symptoms and bilaterality, genetic testing was recommended, but he was unfortunately immediately lost to follow up. Go to www.retinarocks.org/cases for more torpedo maculopathy cases. [This case can be found on www.retinarocks.org in the Image Gallery, Torpedo maculopathy (RPE nevus) folder, Torpedo maculopathy IVZ-20250206] Have an interesting case and want to help your peers learn something about the retina? Submit your images at www.retinarocks.org. Retina Rocks and its charitable foundation, "Eye Reach" are supported in part by Optos (@optomap) and Topcon Healthcare (@topconhealthcare). Retina Rocks is the image bank for the Retina World Congress (@RetinaWorldCongress). #torpedomaculopathy #rpenevus #retina #optometry #ophthalmology #cool #odsonfacebook #adarshcharitablefoundation #UWF #optos #optomap #TopconHealthcare #savingsightsavinglives #RetinaWorldCongress by @retina.rocks
0
10 days ago
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Angioid streaks with macular neovascularization and traumatic subretinal blood Streaks, Leaks, and Bad Decisions This 45YO female has a history of osteogenesis imperfecta (OI) and complained of several weeks of central vision loss in her right eye. Two months earlier, she was hospitalized following a fall in which she hit the left side of her face, resulting in a concussion and intracranial hemorrhage. Vision was counting fingers OD and 20/20 OS. Optos color RGB imaging shows bilateral angioid streaks with a peau d’orange appearance to the posterior poles (images 1 and 2). There are numerous small deep vs subretinal hemorrhages scattered throughout the right macula (image 2). Triton swept-source OCT shows cystic retinal thickening. Multiple atypical subretinal hemorrhages mostly parallel the radiating angioid streaks in her left eye (image 2). Fundus fluorescein angiography shows diffuse submacular staining OD, a speckled pattern of hypofluorescence from the angioid streaks OU, and blockage from the subretinal blood OS (image 3). Initially described by Doyne in 1889, angioid streaks are irregular, orange-yellow, crack-like dehiscences in Bruch's membrane, associated with atrophic degeneration of the overlying RPE. The term “angioid” derives from its resemblance to blood vessels. Although they have historically been mistakenly associated with numerous conditions, the only true clinically relevant disorder is with pseudoxanthoma elasticum (PXE; Nadelmann et al, Eye 2023;37:1596-1601). Patients are at significant risk for vision loss from MNV or pattern dystrophy-like changes (Murro et al, Graefe's 2020;258:1881-1892). Even minor trauma with angioid streaks can cause subretinal hemorrhaging and choroidal ruptures (Agrawal et al, JAMA Ophthalmology 2017;135(3):e165466). Unlike typical choroidal ruptures that are usually curvilinear with the nerve, the lesions from the brittle Bruch’s membrane in PXE appear as numerous irregular ruptures usually radiating from the nerve. The subretinal hemorrhages in our patient’s left eye were felt to be avascular, unlike the macular neovascularization (MNV) in her right eye. Keep reading in the comments above 👆👆👆 by @retina.rocks
1
11 days ago
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Pseudo-uveal malignant melanoma from choroidal hemangioma Melanoma Cosplay This 49YO female complained of 2 months of distorted and blurred vision in her right eye and was referred for a possible uveal malignant melanoma (MM). Vision was 20/200 OD and 20/40 in her normal OS. Optos color RG imaging shows a hyperpigmented subretinal lesion measuring 10.8x8.6 mm centered beneath the superotemporal arcade (image 1). However, both RGB imaging and Triton color photography (image 2) reveal that this lesion is orange. A hyporeflective 1.4mm thickened choroidal lesion is noted on OCT scanning with mild subfoveal fluid. Fundus autofluorescence (FAF) shows the lesion to have a central mottled hyper- and hypo-FAF appearance, with surrounding hyper-FAF extending inferiorly. Isolated choroidal hemangiomas are benign vascular lesions. Although they have no malignant potential, they can cause vision loss from exudation leading to subretinal and intraretinal fluid, which can be treated with photodynamic therapy (see Tsipursky et al., Surv Ophthalmology 2011;56:68-85). This lesion was initially misdiagnosed as a uveal malignant melanoma based on the hyperpigmented appearance on Optos RG imaging. This has also been reported in the literature (Becker et al, OSLIR 2023;54:292-296). These images are generated from a red (635nm) and green (532nm) laser. This creates a greenish tint, which distorts the true fundus color. In our patient, this was quite dramatic, with the true orange color of the hemangioma only evident in the Triton image. A newer Optos true color RGB unit has recently been introduced, which maintains the ability to view the separate RG channels but also generates a true-to-life color image. Photodynamic therapy was performed for the foveal fluid. Six weeks later, the fluid completely resolved and vision remained stable at 20/100. We will continue to follow her closely. Go to www.retinarocks.org/cases for more choroidal hemangioma cases. [This case can be found on www.retinarocks.org in the Image Gallery, Hemangioma choroidal folder, Hemangioma choroidal IFG-20240522] Keep reading in the comments above 👆👆👆 by @retina.rocks
1
12 days ago
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Rhegmatogenous RD with peripheral macro-pseudocysts Cysts happen! Detachment With Extra Baggage Today’s Retina Foundation case was submitted by Anand Gandhi (@anandgandhi1) and Manish Nagpal (@drmanishnagpal). This healthy 43YO male presented with inferotemporal field loss in his right eye for 2 weeks. Vision was 20/20 OU. Pseudocolor SLO imaging (image 1) shows a superonasal macula-on rhegmatogenous retinal detachment (RRD, yellow arrows) with two prominent retinal cysts. OCT (image 2) confirms the retinal detachment with cystic outer retinal fluid within the detachment (green arrow) and within the outer margin of a cyst (orange arrow). Emergent pars plana vitrectomy was scheduled. A retinal cyst is defined as a fluid-filled space in or derived from the retina, the diameter of which is greater than the thickness of the normal retina. They most commonly occur in chronic retinal detachments and have historically been described as retinal macrocysts (Liu et al, JAMA Ophthalmology 2018;136:956-958). The lining of these cavities localizes to the outer plexiform layer, indicating that the lesions result from intraretinal splitting rather than representing true cysts. In our experience, these cysts promptly resolve following retinal reattachment and therefore don’t need to be drained directly during retinal reattachment surgery. Go to www.retinarocks.org/cases for more RRD cases. [This case can be found on www.retinarocks.org in the Image Gallery, Retinal detachment (RD) rhegmatogenous (RRD) folder RRD MEH-20260604] Have an interesting case? Submit your images at www.retinarocks.org. Retina Rocks is the image bank for the Retina World Congress (@RetinaWorldCongress). #retinalcyst #retinaldetachment #retina #optometry #ophthalmology #cool #odsonfacebook #TopconHealthcare #adarshcharitablefoundation #RetinaWorldCongress by @retina.rocks
6
13 days ago
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