Abstract
A patient presented to the neuro-ophthalmology clinic after referral from his primary retina physician for further evaluation of a point of light seen in his left eye. The patient had no significant past medical history, but had a past ocular history of pathologic myopia in both eyes complicated by a choroidal neovascular membrane and a retinal detachment in the right eye; bilateral cataract surgery; and laser retinopexy for a retinal tear in his left eye. The patient described seeing a constant, single point of light "like a fiber optic light" in his left eye over the last year, without fluctuations or variation, and present with his eyes closed. He noted the light has slightly decreased in brightness over the last year. He had had several examinations with his primary surgeon to rule out other retinal tears or detachments over this period. On examination he had 20/300 vision in his right eye, 20/20 vision in the left eye, with an afferent pupillary defect (APD) on the right eye. The anterior segment was unremarkable apart from the posterior chamber intraocular lenses, and the posterior segment was significant for the findings consistent with his above history. The left eye was noted to have a grayish-yellow lesion inferior to the optic nerve, and when this area was imaged with OCT, a cavitation underneath the RPE-Bruch's membrane complex was discovered adjacent to an area of choroidal thickening, consistent with a peripapillary intrachoroidal cavitation (PICC). The location of this lesion corresponded exactly to the location in space where the patient noted this point of light. This is to our knowledge the first description of a patient who was symptomatic from a PICC lesion. The patient will follow up with visual field testing to monitor for future changes to this area.
Presentation Date: 05/08/2025
Issue Date: 07/18/2025