PMC9285110_01
Preoperative optical coherence tomography of the optic nerve head showing cupping and thinning of the neuroretinal rim at its inferior aspect
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F1
Preoperative eye examination was significant for glaucomatous optic neuropathy with advanced neuroretinal rim thinning and disc pallor, as demonstrated by optical coherence tomography (OCT) of the optic nerve head (Figure 1 (Fig. 1)).
Slit lamp photographs showing (A) fine rubeosis affecting the pupil edge and iris (yellow arrowheads) and (B) low rise and increased vascularity on the filtering bleb
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F2
On biomicroscopy, fine rubeosis on the pupil edge, iris surface, and angles were identified (Figure 2A (Fig. 2)). There was a low bleb with increased vascularity (Figure 2B (Fig. 2)).
Fundus photograph showing features consistent with both CRAO and CRVO, including dilated and tortuous veins (yellow arrowhead), ischemic retinal whitening with a cherry red spot (white arrowhead), and sclerosed arteries (light blue arrowhead), as well as sclerosed veins with boxcarring of red blood cells (dark blue arrowhead)
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F3
Fundoscopy revealed dilated and tortuous retinal veins, sclerosed retinal arteries and veins with boxcarring of red blood cells, numerous intraretinal hemorrhages, and retinal ischemic whitening with a cherry red spot - findings consistent with both CRAO and CRVO (Figure 3 (Fig. 3)).
Optical coherence tomography scan showing hyperreflective and thickened inner retinal layers that correspond to retinal edema as well as mild cystoid changes in the fovea
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F4
There was also minimal cystoid macular edema at the fovea (Figure 4 (Fig. 4)).
Fluorescein angiogram showing delayed filling of arteries, increased arteriovenous transit time with subsequent delay in venous filling, widespread capillary nonperfusion, and minimal macular edema
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F5
Fundus fluorescein angiography (FFA) done at presentation (Figure 5 (Fig. 5)) showed delayed filling of the retinal arteries with an arm-to-retina time of 46.6 seconds.
Multimodal imaging after 3 months of treatment; (A) fundus photograph showing optic atrophy and sclerosis of all retinal vessels with residual intraretinal hemorrhages; (B) optical coherence tomography scan showing generalized retinal atrophy more prominent in the inner retinal layers; (C) optical coherence tomography angiography showing absence of blood flow within the retinal vessels in both the superficial and deep capillary plexuses
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F6
Fundoscopy showed widespread retinal atrophic changes with sclerosis of all retinal vessels, as well as optic atrophy (Figure 6 (Fig. 6)).