Vol 126, No. 9, September 2008 Archives Clinical Challenge: You Make the Diagnosis Retinal Findings in a 29-Year-Old Man REPORT OF A CASE A 29-year-old man exhibited arcs of increased fundus autofluorescence with a crescentlike distribution surrounding an area of retinal pigment epithelium atrophy. In the left eye, the central macula was surrounded by a ring of increased fundus autofluorescence that was broadened at the temporal side. Microperimetric assessment revealed the appearance of normal light sensitivity in the central macula and severely reduced light sensitivity in areas that were demarcated by the arc of increased fundus autofluorescence. Simultaneous confocal laser scanning ophthalmoscopy and high-resolution spectral-domain optical coherence tomography were performed (Figure 1 and Figure 2). What is your diagnosis? Figure 1. Right eye of patient. Simultaneous fundus autofluorescence and spectral-domain–optical coherence tomographic imaging. The line of increased fundus autofluorescence corresponds with a junctional zone (B and C, within black lines). RPE indicates presumed correspondence of the retinal pigment epithelium; IPRL, interface of the inner/outer segments of photoreceptors; ELM, external limiting membrane; ONL, outer nuclear layer; OPL, outer plexiform layer; INL, inner nuclear layer; IPL, inner plexiform layer; GCL, ganglion cell layer; and RNFL, retinal nerve fiber layer. View a larger version of Figure 1. Figure 2. Left eye of patient. Simultaneous fundus autofluorescence and spectral-domain–optical coherence tomographic imaging. Arrows indicate transition zones with increased fundus autofluorescence. Sections *, †, and ‡ in panel B correspond to those in panel C. †In the broadened area with increased fundus autofluorescence (within black lines), the external limiting membrane (white lines indicate the presumed location) appears more distant from the retinal pigment epithelium layer. View a larger version of Figure 2. Please e-mail your diagnosis to ophthquiz{at}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 Web site and will also be able to choose one of the following books published by AMA Press: Clinical Eye Atlas, Clinical Retina, or Users’ Guides to the Medical Literature. 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 Archives of Ophthalmology. Congratulations to the winner of our August quiz, Mona N. Mansour, MS, Department of Ophthalmology, Al-Zahraa University Hospital, Al-Azhar University, Cairo, Egypt. The correct answer to our August challenge was retinoblastoma. For a complete discussion of this case, see the Small Case Series section in the September Archives (Sarafzadeh S, Corrêa ZM, Augsburger JJ. Familial retinoblastoma with unilateral and unifocal involvement in 2 families. Arch Ophthalmol. 2008;126[9]:1308-1309). Next month's quiz will be available on October 13, 2008, at 3 pm Central time.