The patient was a 74-year-old woman with a history of a retinal detachment in the right eye treated with vitrectomy and a scleral buckle in 2001, who complained of decreased vision in the right eye for two days. She experienced a total loss of vision in the right eye while vomiting, which lasted for 30-40 minutes. During that time, she saw sparkling lights. Subsequently, when looking at her kitchen tiles there was distortion, and tiles down and to the left of her central vision seemed “skewed” when using her right eye. She had no recent visual changes in the left eye. Her past medical history was remarkable for Waldenstrom’s macroglobulinemia diagnosed 15 years previously that had not caused significant systemic problems.
The visual acuity was 20/30-1, J1 OD and 20/70, pinhole 20/40, J2 OS. The anterior segment was remarkable for pseudophakia without capsular opacity in both eyes. The posterior segment examination revealed a quiet and empty vitreous in the right eye and a posterior vitreous separation and nonpigmented vitreous debris in the left eye. Fundus findings can be discerned from the images. What was the most likely diagnosis? What treatment, if any, was indicated?
