Thank you very much for all your replies. I will order more tests.
The patient did not have any history of fever or flu prior to vision loss. After cataract surgery, the patient had many examinations locally, including OCT line scan, all of which showed no abnormalities. The cataract surgery went very smoothly, so it is not a problem with the surgery. However, I am hesitant to differentiate between optic nerve diseases and retinal diseases.
I once had a patient with cone dystrophy (POC1B gene) who had symmetric bilateral GCC thinning and temporal RNFL thinning with large central scotoma. The OCT pattern of that case fooled me. But in that case, the macular line scan showed abnormalities in IS/OS and the patient had obvious photophobia. The macula line scan of this patient was normal.
Another question: Is central scotoma common in autoimmune retinopathy?
I agree with Dr. Chen's opinion that the improvement of vision may be due to eccentric fixation.
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Yan
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Original Message:
Sent: 07-16-2025 19:19
From: Yanjun Chen
Subject: Bilateral Visual Decline Post-Cataract Surgery in a 64-Year-Old Female
With bilateral painless visual loss, central scotoma, profound OCT GCC thinning but preserved RNFL, I would include Leber's in the differential. In addition to the three classic mutations, fewer than a dozen other pathogenic variants have been identified. They can lead to varying degrees of visual loss.
I had a patient who lost vision in one eye a few days following cataract surgery, which ultimately turned out to be GCA. This case does not strongly suggest GCA.
Best,
Judy
Original Message:
Sent: 7/15/2025 9:48:00 AM
From: Yan Yan
Subject: Bilateral Visual Decline Post-Cataract Surgery in a 64-Year-Old Female
Dear All，
I have a patient and need suggestions. Any opinions are welcome.
Female, 64 years old, underwent bilateral cataract surgery one and a half months ago, with a postoperative BCVA of 20/30. She had hypertension and DM, without history of cancer. One month ago, she suddenly experienced a simultaneous decrease in vision in both eyes, without pain on eye movement or headache. She complains of vision like looking through fog and things appearing brighter, but there is no significant photophobia or obvious dimming of vision. At that time, the visual acuity recorded by the local doctor was 20/200.
One month later, I saw the patient. She reported that her vision had improved somewhat but was still not clear. The BCVA was found to have recovered to 20/40. Color vision: 0/8, RAPD was negative. The anterior chamber was quiet. No cells in the vitreous. The optic nerves and retina were normal. Autofluorescence was normal. Static perimetry showed a small central scotoma in the left eye, and a larger central scotoma and inferonasal scotoma in the right eye. MRI of the brain and orbits w/o contrast was normal. Macular OCT line scan (inner retina and photoreceptors, RPE) was normal. The GC-IPL (Zeiss) was symmetrically thinned by 60 microns in both eyes, and the thickness of RNFL in all quadrants was normal. MfERG showed a severe decrease in macular response. Full-field ERG showed a significant decrease in light adaptation responses in both eyes, and a mild decrease in all dark adaptation responses.
What further tests are needed? What could be the possible diagnosis?
Thanks!
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Yan
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