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Vol 130, No 11, November 2012

Archives Clinical Challenge: You Make the Diagnosis

Hyperreflective Opacities Near the Inner Fovea in a 43-Year-Old Woman


A 43-year-old African American woman was referred by her optometrist for bilateral macular lesions found during routine eye examination. She was asymptomatic and had a best-corrected visual acuity of 20/20 OU. She had no medical or ocular history and was taking no medications. On fundus examination, there were bilateral white, granular opacities located in the fovea, with a higher-density “ring” formed by the granules at the peripheral edge of the fovea. Spectral-domain optical coherence tomography revealed hyperreflective opacities located in the inner aspect of the fovea, with an otherwise normal retinal appearance and contour in both eyes. A partial posterior vitreous detachment with vitreofoveal attachment was evident on optical coherence tomography of the left eye (Figure).

What is your diagnosis?

Image of figure 1

Spectral-domain optical coherence tomography images of the right (OD) (A) and left (OS) (B) macula reveal fine, highly reflective granular material within the innermost layer of the fovea. Original magnification x2 images of the fovea are shown in the insets, and an arrow points to the white, hyperreflective material.

Please e-mail your diagnosis to ophthquiz@ama-assn.org. You must include your full name, mailing address, and institutional affiliation in the initial e-mail to be eligible to enter the quiz. The first correct respondent will be recognized in the print journal and on our website and will receive a 1-year complimentary online subscription to Archives of Ophthalmology. Because of the volume of responses we are able to respond to the first person with the correct answer only.

For a complete presentation of this case and an in-depth discussion of the entity, please see next month's edition of the Archives.

Congratulations to the winner of our October quiz, Muhammad S. A, Raja, MRCOphth, FRCS, Department of Ophthalmology, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, England.

The correct answer to our October challenge was idiopathic pigmented vitreous cyst.

For a complete discussion of this case, see the Research Letters section in the November Archives (Gupta SR, Gupta N, Anand R, Dhawan S. Idiopathic pigmented vitreous cyst. Arch Ophthalmol. 2012;130[11]:1494-1496).

Next month's quiz will be available on December 10, 2012, at 3pm Central time.