PMC8801569_01
A fundus photo and fluorescein angiography of the right eye. (A) Optos wide-field fundus image showing a branch of each artery and vein of the inferior retinal arcade, extending into macula with a sharp angle. (B) Magnified image demonstrating a better view of the macula. (C) Late fluorescein angiography, revealing no leakage of these vessels, the formation of the fovea avascular zone by the terminal arterioles, and the fovea-spared routine of the vein.
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Fundus examination revealed a branch of artery and vein of the inferior retinal arcade extending into macula with a sharp angle (Figures 1A,B) (Optos, Optos PLC, Dunfermline, UK). Fundus fluorescein angiography (FFA) revealed no arteriovenous anastomoses and no leakage of these vessels, the formation of fovea avascular zone (FAZ) by the terminal arterioles, and the fovea-spared routine of the vein (Figure 1C).
The 3 x 3 mm optical coherence tomography angiography images of the macula. (A) Total retinal flow of macula. (B) Superficial retinal flow of macula. (C) Deep retinal flow of macula.
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Macular 3 mm x 3 mm optical coherence tomography (OCT) angiography (AngioVue, Optovue RTVue XR 100; AVANTI, Inc) confirmed the preservation of FAZ with more vascular details (Figure 2A). The vein remains in the superficial layer of the retina (Figure 2B), and the artery strays into the deep capillary plexus (Figure 2C).
Optical coherence tomography (OCT) through the fovea and infra-red images of the macula. (A) Initial OCT of the right eye, demonstrating cystoid macular edema. (B) Infra-red image of the macula, showing the sites of arteriovenous impression (arrowheads) and the shadow of the swollen never-fiber layer on retinal pigment epithelium (RPE). (C) OCT of the right eye at 2-week follow-up visit, revealing the absorption of macular edema. (D) Infra-red image of the macula at a 2-week follow-up visit, exhibiting the disappearance of the shadow.
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An infra-red image demonstrated a better view of the entanglement of these two vessels as the vein crossing the artery from below (a red arrowhead) to above (a yellow arrowhead) (Figure 3B). OCT through the fovea showed macular edema (Figure 3A) (Spectralis OCT, Heidelberg Engineering, Inc., Heidelberg, Germany), which may lead to decreased visual acuity. At the 2-week follow-up visit, the BCVA of the patient improved to 20/20, and macular edema was completely absorbed (Figures 3C,D).