PMC10073982_01
Previous reports on macular neovascularization associated with Bietti crystalline dystrophy
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T1
Fundus examination disclosed a normal looking optic disc and almost symmetrical widespread refractile white-yellow retinal deposits radiating 360  from posterior pole towards the equator bilaterally (Figure 1A/D (Fig. 1)) and there was a slightly pigmented atrophic-looking area adjacent to the temporal disc rim in OD. Fluorescein angiogram (FA) (Heidelberg Spectralis, Heidelberg Engineering, Heidelberg, Germany) revealed bilateral circular-looking late staining corresponding to the subtle atrophic areas at the posterior pole (Figure 1B/E (Fig. 1)). Fundus reflectance image exhibited multiple bright dots surrounding the both foveas (Figure 1C/F (Fig. 1)) and enhanced depth optical coherence tomography (OCT) (Heidelberg Spectralis, Heidelberg Engineering, Heidelberg, Germany) examination revealed a few intraretinal hyperreflective dots and hyperreflective plaque-like accumulations on the RPE-Bruch's membrane (Figure 1G/J (Fig. 1)). While outer retina slab of optical coherence tomography angiography (OCT-A) (Triton, Topcon Inc., Oakland, New Jersey, USA) was bilaterally almost normal (Figure 1H/K (Fig. 1)), choriocapillaris slabs demonstrated a few areas of flow deficit (Figure 1I/L (Fig. 1)).
Color fundus pictures (A, right eye and D, left eye); normal optic disc and almost symmetrical widespread refractile white-yellow retinal deposits radiating 360  from posterior pole towards the equator. Venous phase of wide-angle fluorescein angiogram (B, right eye and E, left eye); bilateral circular late staining corresponding to the subtle atrophic areas at the posterior pole. Reflectance images (C, right eye and F, left eye) and enhanced depth optical coherence tomographic sections (G, right eye and J, left eye); red arrows show intraretinal hyperreflective dots, yellow arrows show hyperreflective plaque-like accumulations on the RPE-Bruch's membrane and blue arrow shows choroidal excavation adjacent to the temporal disc rim in OD. Optical coherence tomography angiography sections outer retina slabs (H, right eye and K, left eye); almost normal outer retina; choriocapillaris slabs (I and L); a few areas of flow deficits.
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F1
The appearance of the right fundus was unchanged but there was a significant foveal retinal hemorrhage in OS (Figure 2A (Fig. 2)). OCT (Figure 2B (Fig. 2)). OCT-A confirmed the presence of the neovascular complex (Figure 2C/D (Fig. 2)).
Color fundus picture of the left eye (A), blue arrow shows foveal retinal hemorrhage. Optical coherence tomographic section of the left eye (B), macular neovascularization and intraretinal cysts. Optical coherence tomography angiographic section outer retina slab of the left eye (C), neovascular tuft of vessels. Optical coherence tomography angiographic section choriocapillaris slab of the left eye (D), a few areas of flow deficit.
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F2
OCT and OCT-A illustrated a very stable looking MNV with a relatively diminished lesion size (Figure 3A-D (Fig. 3)).