PMC8695004_01
Fundus photos of right and left eyes. (a, b) Three days before beginning plasmapheresis. Prominent vascular tortuosity and white-centered peripheral lesions. Faint sclerotic vessels with box-carring-like changes apparent in the far nasal and temporal periphery of both eyes, possibly the result of pseudovasoocclusive events in the setting of venous stasis. (c, d) One week after finishing the third round of plasmapheresis. Dramatic improvement in the white-centered peripheral lesions is apparent. There is also a reduction in the box-carring-like changes in the periphery. (e, f) One and a half years later, there is sustained resolution of the white-centered peripheral lesions, but still some vascular tortuosity.
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fig1
Upon reexamination, new vitreous hemorrhage, white-centered peripheral lesions, and increasing vascular tortuosity were noticed (Figures 1(a) and 1(b)). The resolution of his white-centered peripheral lesions was sustained nearly one and a half years later (Figures 1(e) and 1(f)).
Fluorescein angiography of right (a) and left (b) eyes, three days before beginning plasmapheresis. Blockage is noted in areas of peripheral white-centered lesions. Capillary drop-out as well as peripheral staining are also apparent.
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fig2
Fluorescein angiography from this time is shown in Figure 2.
OCT angiography of the right retina, nasal to the fovea, before and one week after finishing plasmapheresis. (a, d) OCT reflectance full layer before (a) and after (d) plasmapheresis. One week after treatment, there was a significant decrease in the hyperreflective lesion nasal to the fovea. (b, e) Full vascular OCT-A layer before (b) and after (e) plasmapheresis. Qualitatively, there is a noticeable decrease in vessel diameter. (c, f) Capillary density maps before (c) and after (f) plasmapheresis. Capillaries are color-coded; large vessels are excluded and shown in white. After treatment, capillary density decreased from 47.62% to 45.35% and large vessel density decreased from 18.87% to 10.16%.
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fig3
The full retinal vascular layer OCT-A located between the inner limiting membrane and 9 mum below the posterior boundary of the outer plexiform layer (Figures 3(b) and 3(e)) was used to measure the capillary and large vessel density. A color-coded density map was created for a rapid qualitative assessment (Figures 3(c) and 3(f)). Pre- and posttreatment en face OCT (Figures 3(a) and 3(d)) and spectral domain OCT (Figures 4(a) and 4(b)) over the white-centered peripheral lesions showed significant resolution of the parafoveal outer nuclear layer hyperreflective material.
Color fundus photos and spectral domain OCT over white-centered peripheral lesions over the right nasal fovea three days before (a) and one week after (b) plasmapheresis show significant resolution of the outer nuclear layer hyperreflective material.
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fig4
Pre- and posttreatment en face OCT (Figures 3(a) and 3(d)) and spectral domain OCT (Figures 4(a) and 4(b)) over the white-centered peripheral lesions showed significant resolution of the parafoveal outer nuclear layer hyperreflective material.