Pavingstone Degeneration

From JAMA: "Of importance in the evaluation of the peripheral fundus is a distinctive and fairly common disease process termed paving-stone degeneration of the retina. In its typical form, this condition is located between the ora serrata and the equator and is characterized by small, discrete, rounded areas of depigmentation and retinal thinning. These lesions are yellow-white in color, frequently reveal prominent underlying choroidal vessels, and often possess a pigmented margin. Occurring singly or in groups, the lesions of paving-stone degeneration not uncommonly become confluent and may even coalesce to form bands."

From OpticianOnline: "DIFFERENTIAL DIAGNOSIS. Gyrate atrophy; Lattice degeneration; Congenital hypertrophy of the retinal pigmentary epithelium; Retinal holes; Inactive chorioretinitis lesions...No treatment is required for pavingstone degeneration. The main issue is the differential diagnosis."

RETINAL HOLE AND LATTICE DEGENERATION

This patient came in for a routine eye examination.  Retinal exam demonstrated a moderate sized retinal break in the right eye.  You can also see areas of lattice degeneration superiorly.  The patient is to undergo laser photocoagulation to prevent retinal detachment.  THIS is why we dilate or perform the Optomap.  People go blind every day from retinal detachments that could have been prevented if they had been caught as a small retinal break. 

Another large superior retinal hole with an operculum floating above it. 

RETINAL HOLE

A great picture of an atrophic retinal hole.

VORTEX VEINS

The above picture is in a patient that has limited RPE pigmentation so the vortex veins can be easily visualized.  This is similar to the peripheral fundus appearance in patients with albinism.

RETINAL DETACHMENT REPAIR

 Above is a montaged Optomap image of a left eye that has undergone retinal detachment surgery with the placement of a scleral buckle.  There is an large artifactual shadow on the left side but the ring shadow over the macula is from a posterior subcapsular cataract that has developed subsequent to the surgery. 

 This is an autofluorescence picture of the same eye.  It clearly delineates the boundaries of the orginal retinal detachment in the nasal retina, barely sparing the macula.  The patient's vision is 20/25, even with the cataract present. 

CONGENITAL HYPERTROPHY OF THE RETINAL PIGMENT EPITHELIUM (CHRPE)

VITREOMACULAR TRACTION

Above is a scan that demonstrates the vitreomacular traction progression over a two and a half year period of time.  The patient's visual acuity is still 20/25.