Disciform Macular Scarring

A sudden, severe decrease in the vision in her left eye brought an 80-year-old woman in for an evaluation. Her best corrected visual acuity was 20/200 in that eye.

The results of external examination of both eyes were unremarkable. A dilated fundus examination of the left eye found a large but subtle serous elevation in the macular area; there were no hemorrhages or exudates. A fluorescein angiogram confirmed an occult subretinal neovascular membrane that completely encompassed the macular area (A).

This patient was originally evaluated 4 years ago, before any viable therapies were available to treat this form of wet age-related macular degeneration. She was observed periodically, but had no treatment.

The patient's vision in the left eye has stabilized at finger counting at 2 feet. She also has a large fibrotic disciform macular scar (B). This is the natural end point of an untreated macular neovascular membrane; there is no known treatment.