PMC3717569_01
(A)Red-free fundus image of the left eye depicting BRVO. Note the presence of intra-retinal hemorrhage typically involving the supero-temporal quadrant (black arrow), as well as scattered areas of hemorrhage temporal to the optic nerve head and involving the macular region (green box). (B) Red-free fundus image of the left eye following laser photocoagulation, showing the resolving intra-retinal hemorrhages. Note the previously observed scattered areas of hemorrhage temporal to the optic nerve head and in the macular region have now resolved, and small hard exudates have appeared typically in the macular region (black arrow). These exudates disappeared completely on follow-up dilated fundus examinations, following which the patient maintained stable vision of 20/30 in his left eye for 6 years. BRVO, branch retinal vein occlusion; PRP, pan-retinal photocoagulation.
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F1
He had an ocular history of branch retinal vein occlusion (BRVO) with macular edema for 10 years in the right and 8 years in the left eye, which had been successfully treated with sectoral pan-retinal photocoagulation (PRP) and focal laser bilaterally [Figure 1].
(A) Color fundus photograph of the left eye showing a yellowish orange, well-defined lesion in the macular region (black arrow). (B) OCT image of the left eye, showing a mild disruption of the RPE (red arrow). There is no evidence of CNV or sub-retinal fluid collection. OCT, optical coherence tomography; RPE, retinal pigment epithelium; CNV, choroidal neovascularization
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F2
However, fundus photography of the left eye revealed a well-circumscribed yellowish orange lesion in the macular region [Figure 2], while OCT showed a slight disruption of the RPE [Figure 2].
(A) Color fundus photograph of the left eye showing a yellowish orange, well-defined lesion with surface depressions and elevations in the macular region (black arrow). (B) OCT image of the left eye, showing an irregular plate-like hyper-reflectivity of the lesion (yellow asterisk) extending into the retina, with atrophy of the overlying RPE (green arrowheads). Sub-retinal fluid collection can also be observed (red arrow). (C) Fluorescein Angiography of the left eye showing leakage of the dye in the region of macula consistent with CNV secondary to the choroidal lesion (black arrow). (D) B-scan ultrasonography of the left eye showing a highly reflective choroidal lesion in the posterior pole (red arrow) and acoustic shadowing just posterior to the mass (green arrow). OCT, optical coherence tomography; RPE, retinal pigment epithelium; CNV, choroidal neovascularization
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F3
After 1.5 years of the initial appearance of the lesion, the patient presented with sudden distortion of vision in his left eye, and was evaluated with fundus photography, which again revealed the previously observed lesion [Figure 3]. Fluorescein angiography (FA) and OCT features were consistent with CNV and sub-retinal fluid collection [Figure 3]. A B-scan ultrasonogram revealed a hyper-reflective choroidal mass in the posterior pole, with posterior acoustic shadowing, consistent with the diagnosis of choroidal osteoma [Figure 3].
(A) Color fundus photograph of the left eye following completion of treatment with intravitreal Bevacizumab, showing a reduction in size, as well as the elevations and depressions of the lesion in the region of macula (black arrow). (B) OCT image of the left eye showing a substantial reduction in the size of the lesion (yellow asterisk). Note that the sub-retinal fluid collection has resolved with treatment. OCT, optical coherence tomography
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F4
At the time of his last follow up, the BCVA in the left eye was 20/25, and fundus photography and OCT showed a substantial improvement [Figure 4].