PMC6689905_01
Colour fundus (CF) images of both eyes at the time of presentation: (a) CF of the right eye showing a glaucomatous disc and hazy media secondary to cataract and (b) CF of the left eye showing an optic disc with high cup:disc ratio of 0.8:1 and presence of preretinal and subretinal haemorrhage at the macula and inferior to the disc and presence of AV crossing changes, arteriolar attenuation, and cotton-wool spots.
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Multiple layered preretinal and subretinal blood was surrounding the optic disc and macula (Figure 1).
Fluorescein angiography (FA) images of the left eye at presentation: (a)-(c) FA images showing blocked fluorescence at the macula due to presence of preretinal and subretinal heme. Also seen is a light-bulb hyperfluorescent lesion deep at the centre of the ONH, suggestive of RAM lesion (blue arrow with blue outline).
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A small focus of light-bulb hyperfluorescent lesion at the centre of the ONH corresponding to the macroaneurysm was noted in the progressive phases of the FA (Figure 2).
Colour fundus image of the left eye 3 weeks post treatment with intraocular gas injection.
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LE BCVA improved to 6/18, N6. LE fundus examination showed resolving retinal and subretinal haemorrhage (Figure 3).
High-definition OCT images through the optic nerve head using the enhanced depth imaging (EDI) mode.. Scan identifies a large bulbous lesion located deep within the optic nerve heave head and communicating with the retinal vessel suggestive of retinal artery macroaneurysm lesion.
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RAM (Figure 4). RE BCVA was counting fingers at 3 m.
Red-free fundus photo of the left eye 2 months post treatment showing the altered residual subretinal blood adjacent to the fovea.
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His BCVA in the LE improved to 6/12, N8 (Figure 5).