Barzilai University Medical Center

121 Research Day 2020 Barzilai University Medical Center 87 SPECTRALIS OCT NSITE SOFTWARE MODULE AS A DIAGNOSTIC TOOL IN A PATIENT WITH ACUTE BILATERAL CENTRAL VISUAL SCOTOMAS Muhammad Biadsy, Iris Boguslavsky, Dua Masarwa, Eyal Aloni Ophthalmology Department, Barzilai University Medical Center, Ashkelon, Israel Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel. Background Nsite Software module of the Spectralis OCT is a new modality that enables measurements of the papillo-macular bundle (PMB) area. The utility of these measurement is still not recognized. The nerve fibers of the PMB area are responsible for central visual acuity. Patients with bilateral acute central visual scotomas are a diagnostic challenge as objective findings might be absent and malingering might be suspected. We will present a patient with acute bilateral central visual loss with only subjective findings that was suspected of being malingering in which the Nsite OCT helped recognize an organic cause to his complaints . Methods Descriptive Case report. Results A 46-year-old healthy male, of Uzbekistan origin, presented to the emergency department with complaints of acute bilateral painless visual loss. On examination, both eyes visual acuity was 6/60 with an Ishihara color test of 0/15 and confrontational visual fields showing bilateral central scotoma with tunnel vision characteristic. Humphrey 24-2 visual fields showed bilateral central scotomas. There was no RAPD. Ocular exam was normal with normal maculas and normal optic nerves. Neurological examination was normal. OCT of the maculas were normal. OCT PMB measurements demonstrated bilateral thickening. An extensive evaluation was initiated that reveled a positive serology for VDRL and TPHA in blood and CSF and also a positive FTA test in the CSF. The patient was diagnosed with neurosyphilis and treated with IV penicillin and IV solumedrol. A few days later, visual acuity returned to 6/9 in both eyes, color vision improved as did his central scotomas. OCT PMB area measurements gradually normalized. Conclusion In this case of acute bilateral central visual loss where there was only subjective clinical finding, OCT PMB area measurements were the only objective finding of a pathology. This finding increased the awareness of an organic etiology and initiated further evaluation that reveled syphilitic optic neuropathy.