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Binasal visual field defects from simultaneous bilateral retinal infarctions in sickle cell disease.

Cusick M, Toma HS, Hwang TS, Brown JC, Miller NR, Adams NA

The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.

PURPOSE: To report a case of retinal occlusive disease producing binasal visual field defects in a patient with sickle cell (SC) disease. DESIGN: Retrospective case report. METHODS: A 21-year-old man with SC disease presented with binasal field defects and 20/20 acuity in each eye. RESULTS: Initial ophthalmoscopy and fluorescein angiography revealed no abnormalities. Optical coherence tomography (OCT) demonstrated bilateral temporal inner retinal hyperreflectivity, and multifocal electroretinography (mfERG) confirmed retinal dysfunction. Several weeks later, ophthalmoscopy and angiography demonstrated macular arteriolar occlusive disease. CONCLUSIONS: Simultaneous bilateral macular occlusive events are uncommon in patients particularly with SC disease. Although the binasal field defects raised the suspicion of a process affecting the optic nerves, the OCT and mfERG proved essential in diagnosing retinal rather than optic nerve disease.

Published 24 April 2007 in Am J Ophthalmol, 143(5): 893-6.
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