PMC10442564_01
(A-C) Color fundus photographs (CFPs) and fundus autofluorescence (FAF) of the right eye. (D-F) CFPs and FAF of the left eye. (A,B) Dotted grayish-white deposits around the retinal vessels (yellow triangles; magnified in B). (C) Hypo-AF corresponding to the grayish-white deposits on the CFPs and mottled hypo-AF (yellow triangles). (D,E) Dotted grayish-white deposits around the retinal vessels. (E) Magnification of the dotted grayish-white deposits around the retinal vessels and segmental deposits around the peripheral vessels (yellow triangles). (F) Hypo-AF corresponding to the grayish-white deposits on the CFPs and linear hypo-AF consistent with the vitreous opacity (yellow triangles).
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fig1
A color fundus photograph (CFP) and ultra-wide fundus photograph (UWFP) of both eyes showed dotted and segmental perivascular grayish-white deposits involving major vessels in the posterior pole and midperiphery with vitreous opacity (Figures 1A,B,D,E, 2A, 3A). Fundus autofluorescence (FAF) showed dotted and segmental hypoautofluorescence around vessels corresponding to the deposits on the CFP (Figures 1C,F). Computed tomography (CT) of the thorax showed well-defined nodules in the right upper lobe and the right middle lobe and nodular calcified lesions with lengths of approximately 5.5 mm in the posterior segment of the right upper lobe and nodular calcified lesions in the right hilum of the lung (Supplementary Figure S1) (the laboratory results are shown in Supplementary Table S2).
Ultra-wide fundus photograph (UWFP) and optical coherence tomography (OCT) of the right eye during follow up. (A) White deposits around the peripheral vessels and vitreous opacity on a UWFP and hump-like hyperreflective materials (HRMs) on the inner limiting membrane/epiretinal retinal membrane (ILM/ERM) at the initial visit. (B) White deposits around the peripheral vessels and vitreous opacity on a UWFP and shrinkage of hump-like HRMs on the ILM/ERM 1 month after oral steroid administration. (C) The disappearance of white deposits around the peripheral vessels and vitreous opacity on a UWFP and the disappearance of hump-like HRMs on the ILM/ERM 6 months after oral steroid administration. The yellow and blue arrows, respectively, indicate PDs and vitreous floaters on the UWFP, and the red arrows indicate PDs on the OCT.
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fig2
A color fundus photograph (CFP) and ultra-wide fundus photograph (UWFP) of both eyes showed dotted and segmental perivascular grayish-white deposits involving major vessels in the posterior pole and midperiphery with vitreous opacity (Figures 1A,B,D,E, 2A, 3A). Optical coherence tomography (OCT) showed hump-like elevated hyperreflective deposits (HRDs) in the interface of the retinal vessels and vitreous cavity (VC), and several clusters of hyperreflective materials (HRMs) in the VC (Figures 2A, 3A). However, the shrinkage of the HRDs was noted by OCT in both eyes (Figures 2B, 3B). HRDs of the right eye resolved and no hyperreflective materials were found in the VC with OCT (Figure 2C). However, in the left eye, the grayish-white deposits seemed to occur much more in the nasal periphery on the UWFP and the size of the HRDs became smaller than before and even disappeared at some sites. Furthermore, the hypofluorescence of PDs and vitreous opacity could be found in the left eye (Supplementary Figure S2).
UWFP and OCT of the left eye at follow up. (A) White deposits around the peripheral vessels and vitreous opacity on a UWFP and hump-like HRMs on the ILM/ERM at the initial visit. (B) White deposits around the peripheral vessels and vitreous opacity on a UWFP and shrinkage of hump-like HRMs on the ILM/ERM 1 month after oral steroid administration. (C) White deposits around the peripheral vessels and vitreous opacity on a UWFP and further shrinkage of hump-like HRMs on the ILM/ERM 6 months after oral steroid administration. (D) Increased numbers of white deposits around the peripheral vessels and vitreous opacity on a UWFP and relapse of hump-like HRMs on the ILM/ERM 2 months after the addition of methotrexate (MTX). (E) The disappearance of white deposits around the peripheral vessels and vitreous opacity on a UWFP and the disappearance of hump-like HRMs on the ILM/ERM 3 months after a dexamethasone intravitreal implant (IVDI). The yellow and blue arrows, respectively, indicate PDs and vitreous floaters on the UWFP, and the red arrows indicate PDs on the OCT.
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fig3
A color fundus photograph (CFP) and ultra-wide fundus photograph (UWFP) of both eyes showed dotted and segmental perivascular grayish-white deposits involving major vessels in the posterior pole and midperiphery with vitreous opacity (Figures 1A,B,D,E, 2A, 3A). Optical coherence tomography (OCT) showed hump-like elevated hyperreflective deposits (HRDs) in the interface of the retinal vessels and vitreous cavity (VC), and several clusters of hyperreflective materials (HRMs) in the VC (Figures 2A, 3A). However, the shrinkage of the HRDs was noted by OCT in both eyes (Figures 2B, 3B). The black floats in the VC were much larger than before (Figure 3C). By contrast, the grayish-white deposits of the left eye increased and the vitreous floaters were not improved (Figure 3D). Notably, 3 months after the intravitreal dexamethasone implant (IVDI) for the left eye, the deposits disappeared on the UWFP, and the HRDs were resolved correspondingly (Figure 3E). The late ICGA showed hyperfluorescence corresponding to the hyperfluorescence on the FFA (Supplementary Figure S3).
Fundus fluorescence angiography (FFA) and indocyanine green angiography (ICGA) at the initial visit. (A,B) FFA shows dotted perivascular hypofluorescence in the posterior pole and midperiphery and some hyperfluorescent dots in the midperiphery, which had leakage in the late phase, and hyperfluorescence of the optic disc was noted in both eyes with late FFA.ICGA shows that those hypofluorescent dots of the FFA remained hypofluorescent with ICGA. The red and blue arrows, respectively, indicate hypofluorescent PDs and vitreous floaters, and the yellow arrows indicate hyperfluorescent leakage.
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fig4
Hyperfluorescence of the optic disc was also noted in both eyes on late FFA (Figures 4A-D). Indocyanine green angiography (ICGA) served to exhibit clear shapes and the sites of these deposits, which had a hypofluorescent appearance (Figures 4E-H). There was only capillary leakage in the posterior pole and midperiphery (Supplementary Figure S4).