PMC7495924_01
Right eye showed central hemorrhage in the color photograph (a), which is due to CNV leakage in FFA (c, d) and ICGA (e, f). FFA and ICGA was recorded simultaneously at the early phase (c, e) and the late phase (d, f). OCT showed discontinuity of RPE layer and subretinal high reflectivity which is consistent with CNV (b). Left eye showed normal structure in the color photograph (g), OCT (h), FFA (i, k) and ICGA (j, l), which is eight months prior to the first presentation in LE.
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A 32-year-old Chinese man with high myopia {-10.5D right eye (RE) and -9.75D left eye (LE)} was referred to our clinic for anti-VEGF intravitreal injection treatment for a paracentral scotoma in the left eye (LE) with no visible evidence of CNV (Figure 1(g)-(l)) in December 2012. Eight months earlier, (April 2012) he had presented with a paracentral scotoma in the right eye (RE), which was diagnosed as CNV (Figure 1(a)-(f)) confirmed by fluorescein angiography (FA) and indocyanine green angiography (ICGA).
FFA showed a small hypofluorescence lesion during the early phase (a) nasal to the fovea (white arrow) This was maintained to the late phase without change (b) when the paracentral scotoma first appeared in the left eye (December 2012). Fundus color photography showed a small red-colored lesion, nasal to the fovea (white arrow)(c). Spectral-domain optical coherence tomography (SD-OCT) demonstrated a dome-shaped elevation in the ellipsoid zone (EZ) and interdigitation zone (IZ) nasal to the fovea (whit arrow)(e). Ten weeks later, just 2 weeks after recovery of initial hemorrhage, a new retinal hemorrhage occurred in his left eye (double white arrow)(e), located temporal to the previous one (white arrow). SD-OCT showed a dome-shaped elevation in the retinal photoreceptor layer similar to the previous one (white arrow)(f). Fundus color photography and SD-OCT showed a left retinal hemorrhage which was absorbed and did not reoccur during follow-up 2 months (g, h) and 12 months (i, j) after cessation of high dose fish oil.
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Fundus photography revealed a subtle red-colored lesion nasal to the left fovea (Figure 2(c)). Spectral-domain optical coherence tomography (SD-OCT)(Topcon Corporation, Tokyo, Japan) revealed a dome shaped elevation in the ellipsoid zone (EZ) and interdigitation zone (IZ) nasal to the fovea (Figure 2(d)) of the LE, without choroid thinning. Neither autofluorescence (AF) imaging or FA (Figure 2(a)-(b)) revealed any CNV. A new dot-like lesion was also observed in the fundus photography (Figure 2(e)) and new dome shaped elevation in the ellipsoid zone and IZ nasal to the fovea was showed by SD-OCT (Figure 2(f)).
When paracentral scotoma first appeared in the left eye in Dec.2012, multifocal electroretinogram (mfERG) showed reduced N and P wave in the nasal parafoveal area either in wave traces (a) or 3D plots (b), which is consistent with the hemorrhage lesion in OCT. Three weeks later, mfERG showed slight recovery in the nasal parafoveal area in wave traces (c) and 3D plots (d).
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Multifocal electroretinogram (mfERG) (EDI, San Mateo, CA) showed reduced N and P wave amplitude in the nasal parafoveal area (Figure 3(a) and (b)), which is consistent with the hemorrhage lesion in SD-OCT. Three weeks later, mfERG showed slight recovery in amplitude in the nasal parafoveal area (Figure 3(c) and (d)). Figure 3(g)-(h) show the results 2 months later and Figure 3(i) and (j), show photos at 6, and 12 months post-cessation of the fish oil supplementation.