PMC5028177_01
Color fundus image of the left eye showed an area of retina whitening, extending along the distribution of three cilioretinal arteries.
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All these clinical and fundus features were compatible with the simultaneous occlusion of three CRAs emerging from the temporal edge of the optic disk (Figure 1).
Fluorescein angiography images revealed only a vertical choroidal watershed centered on the optic disk, a faint screen effect in the perifoveal area due to intraretinal edema, and a normal CRA perfusion.. Abbreviation: CRA, cilioretinal artery.
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At the following day, FFA evidenced only a vertical choroidal watershed centered on the optic disk, a faint screen effect in the perifoveal area due to intraretinal edema, and a normal CRA perfusion (Figure 2).
A horizontal, cross-sectional OCT tomogram through the fovea disclosed diffuse thickening of the neurosensory retina.. Notes: Increased reflectivity was noted in the inner retinal layers from the surface of retina to the photoreceptor layers. Decreased reflectivity was observed from the photoreceptor layers and the retinal pigment epithelium secondary to the shadowing effect. Foveolar depression, photoreceptor layer in the fovea, and retinal pigment epithelium underneath the fovea were normal.. Abbreviations: OCT, optical coherence tomography; N, nasal; S, superior; T, temporal; I, inferior.
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An OCT (Zeiss Cirrus HD-OCT; Carl Zeiss Meditec AG, Jena, Germany) examination revealed an increased reflectivity and a diffuse thickening of the inner retinal layers (Figure 3).
Visual field of the left eye (SITA-Fast Central 30-2 strategy) immediately (A) and after 3 months (B) since CRA occlusion.. Abbreviation: CRA, cilioretinal artery.
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At visual field examination (SITA-Fast Central 30-2 strategy; Carl Zeiss Meditec AG), central scotoma and generalized retinal sensitivity reduction, with a foveal threshold of 5 dB, mean defect of -13.68 dB, and pattern standard deviation of 10.35 dB, were diagnosed (Figure 4A). The visual field showed the reduction of central scotoma with a foveal threshold of 29 dB, mean defect of -10.36 dB, and pattern standard deviation of 11.88 dB (Figure 4B).
The macular thickness map, which was generated by means of OCT after 3 months since CRA occlusion, demonstrated thinning along the distribution of three cilioretinal arteries.. Abbreviations: OCT, optical coherence tomography; CRA, cilioretinal artery; ID, identity; DOB, date of birth; OD, right eye; OS, left eye; ILM, internal limiting membrane; RPE, retinal pigment epithelium; N, nasal; S, superior; T, temporal; I, inferior.
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OCT imaging evidenced macular atrophy subsequent to the acute edematous change in the eye and diffuse macular thinning (Figure 5).