PMC6628513_01
(a) The fundus picture of the left eye at the presentation, showed venous
dilation, (b) The early arteriovenous (AV) phase of fundus fluorescein
angiogram (FFA) image showed a slowly progressing front edge of the dye (*)
in the superotemporal retinal artery (suspected cilioretinal artery) and
delayed filling of the superotemporal retinal vein. The perfusion of whole
choroid seems delayed and compromised, (c) Late AV phase, showed the area of
choroidal ischemia, and sluggish flow in the superotemporal retinal artery
(*), (d, e) Mid phase showed disk leak and the horizontal area of choroidal
ischemia (in between arrowheads), (f) Late phase showed obvious disk leak
and paravascular staining.
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The fundus showed dilated veins in both eyes (Figure 1(a) and 2(a)). There was delayed filling of the superotemporal artery with visible leading edge in the left eye (Figure 1(b),  ). The filling of the superotemporal vein was also delayed in the LE (Figure 1(b)). A horizontal band of hypofluorescence was noted at the level of the choroid in the LE (Figure 1(c), (d), (e), (f)). Staining of the optic nerve head was more prominent in the LE (Figure 1(e) and (f)). Peripheral capillary nonperfusion (CNP) and microaneurysms were seen in both eyes (Figure 1(d)). Paravascular staining was noted in the LE in late phases of FFA (Figure 1(d) and (f)).
(a) The right fundus at presentation, (b) Early phase of FFA revealed
irregular caliber of the retinal arterioles and microvascular abnormality
around the fovea and temporal microaneurysms, (c) The late FFA image of the
right eye showed mild perifoveal capillary leak, (d) The optical coherence
tomography (OCT) scan of the right fovea showed normal foveal contour and
absence of intraretinal/subretinal fluid, (e) The vertical optical OCT scan
(going from inferior to superior) of the left fovea shows mild inner retinal
thinning of the superior macula.. FFA: fundus fluorescein angiogram.
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The RE showed perifoveal capillary changes with mild late leak (Figure 2(b) and (c)). Optical coherence tomography (OCT) macula of RE was unremarkable (Figure 2(d)). There was some inner retinal thinning in the superior macula of the LE (Figure 2(e)).
(a) Four and half months after carotid endarterectomy, the choroidal and
retinal ischemia has markedly improved, but there is still some paravascular
capillary leakage (b) in the late phase and disk leak, (c) Eleven month
after the procedure, left eye showed neovascularization of the disk. The
arterial phase (d) showed impaired choroidal perfusion and arterial dye
front in the superotemporal retinal artery. The arteriovenous phase (e)
shows sluggish arterial circulation, and evident recurrent choroidal
ischemia. Late phase (f) shows severe paravascular and capillary leak and
disk leak. Peripheral retinal capillary nonperfusion areas were noted (g, h,
i).
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The FFA showed significantly improved perfusion, decreased choroidal ischemia, and disk staining (Figure 3(a) and (b)) in the left eye. There were fine new vessels at the disk (NVD) superiorly (Figure 3(c)). FFA showed leak from the NVD and severe recurrence of the choroidal and retinal ischemia (Figure 3(d)-(f)) in the LE. Laser of peripheral capillary nonperfusion areas (Figure 3(g)-(i)) was done in LE.
(a) Fundus photo of the left eye two and a half month after carotid stenting,
(b, c, d) Corresponding FFA showed improved retinal and choroidal
circulation, (e) Fundus photo after 2 and 1/2 years of carotid stenting of the
left side, (f, g, h) FFA shows subtle residual choroidal ischemia and mild
disk staining in the late phase (h).. FFA: fundus fluorescein angiogram.
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However, the FFA features showed some residual choroidal ischemia and leak in the inferior macula (Figure 4(a)-(d)). On FFA, the choroidal ischemia improved much with some remaining late disk hyperfluorescence (Figure 4(e)-(h)).