PMC7488865_01
Image findings at initial visit, right eye . A) Fundus photograph demonstrating an aberrant retinal venous macrovessel draining into the inferotemporal major vascular arcade vein. A suspected anomalous arteriovenous communication with retinal artery can be detected. A yellowish white area is also seen on the fovea around the arteriovenous communication. B) An OCTA image of the superficial capillary plexus slab demonstrating an aberrant vessel, an anomalous arteriovenous communication between the aberrant vessel and the retinal artery, and a distorted foveal avascular zone. C) An OCTA image of the deep capillary plexus slab showing shadowing and projection artefacts due to the aberrant vessel. Cystoid macular edema can also be seen. D) OCT image depicting cystoid macular edema and serous macular detachment. A few hyperreflective dots in the ganglion nerve fiber layer with backshadowing can also be seen along the course of the aberrant vessel around the fovea. E) Fluorescein angiogram (arterial phase) demonstrating early filling of the venous macrovessel with anomalous arteriovenous communication. Watershed zone of the choroid around the optic disc can also be seen. F) Fluorescein angiogram (late venous phase) demonstrating late dye leakage and pooling from the anastomotic vessel.
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F1
There appeared to be a suspicious anomalous arteriovenous communication with a retinal artery (Figure 1A (Fig. 1)). Optical coherence tomography angiography (OCTA) imaging of the superficial vascular plexus in the right fundus revealed the presence of an aberrant vessel, an anomalous arteriovenous communication of the aberrant vessel with the retinal artery, and a distorted foveal avascular zone (Figure 1B (Fig. 1)). The deep vascular plexus slab of the right fundus revealed shadowing and projection artefacts due to the aberrant vessel and cystoid macular edema (Figure 1C (Fig. 1)). A few hyperreflective dots in the ganglion nerve fiber layer with backshadowing were also seen along the course of the aberrant vessel around the fovea (Figure 1D (Fig. 1)). Watershed zone of the choroid around the optic disc was also noticed in the early phase of the angiogram (Figure 1E (Fig. 1)). Capillary bed abnormalities, late dye leakage and pooling from the anastomotic vessel were also noted (Figure 1F (Fig. 1)).
Image findings at six weeks, right eye. A) Fundus photograph demonstrating regression of the macular yellowish white lesion. Stellate, fine, hard exudates forming an incomplete macular fan can also be noticed. B) An OCTA image of the superficial capillary plexus slab demonstrating an aberrant vessel and an anomalous arteriovenous communication. A decreased vascular density can be seen around the foveal avascular zone. C) An OCTA image of the deep capillary plexus slab demonstrating a regression of shadowing and projection due to cystoid macular edema and serous macular detachment. Branches of the macrovessel can be identified clearly (arrows). D) OCT image depicting complete regression of cystoid macular edema and serous macular detachment with a normal foveal contour. Multiple hyperreflective dots can be seen at the ganglion nerve fiber and outer nuclear layers. E) Fluorescein angiogram (early venous phase) demonstrating abnormal vascular branches without leakage. F) Fluorescein angiogram (late venous phase) demonstrating abnormal vascular branches and microvascular abnormalities without leakage or pooling of the dye.
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F2
Fundus examination of the right eye revealed the formation of a few stellate, fine, hard exudates, with a significant regression of the yellowish white lesion seen during the patient's earlier visit (Figure 2A (Fig. 2)). OCTA imaging of the right eye showed abnormal vascular anastomoses with the retinal macrovessels in the superficial vascular plexus slab (Figure 2B (Fig. 2)) and microvascular changes in the deep vascular plexus slab. Branches of the macrovessel could be detected more clearly on the deep capillary plexus slab (Figure 2C (Fig. 2)). However, the cystoid macular edema and serous macular detachment detected during the earlier OCT imaging were not to be seen (Figure 2D (Fig. 2)). FA imaging showed no leakage or pooling (Figure 2E, F (Fig. 2)).