PMC8720613_01
Inflammation was present in the right eye. (a) The fundus was opaque, and exudation and hemorrhage could be seen in the macular and inferonasal peripheral retina. (b) Dense vitreous opacities obscured the visualization of the fundus of the right eye. Chorioretinitis with exudation and hemorrhage was seen in the macular. (c) Normal fundus of left eye. (d, e) OCT showed an epiretinal membrane above the inner retinal surface of macular fovea and pigment epithelial detachment (PED).
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fig1
Chorioretinitis with exudation and hemorrhage were present in the macular and inferonasal peripheral retina (Figures 1(a) and 1(b)). The fundus of the left eye is normal (Figure 1(c)). Optical coherence tomography (OCT) showed epiretinal membrane on the inner retinal surface of macular foveal and pigment epithelial detachment (PED) (Figures 1(d) and 1(e)).
Infectious chorioretinitis and RAP were identified in the right eye. (a) The crooked retinal arterioles and retinal venules extend into deeper layers in the macula. (b, c) OCT showed a thickened epiretinal membrane, hyperreflective material located at the level of the outer retinal layers, and vascularized PED in macular fovea of the right eye. (d-f) OCTA detected abnormal vascular networks in the superficial retinal capillary plexus (d), deep retinal capillary plexus (e), and choroid layers (f). (g-j) Fundus fluorescein angiography (FFA) of the patient: (g) a central, intraretinal hyperfluorescent lesion was visible, which is probably fed by the retinal arteriolar vessel at 2 o'clock; (h) progressive filling of the venous circulation, connected to the hyperfluorescent lesion; (i) the central, intraretinal vascular complex was clearly recognizable in macular, and a round hyperfluorescent lesion was detected at inferonasal peripheral retina; (j) leakage of fluorescent dye from the vascular complex, abnormal dilation of the capillaries, and the hyperfluorescent lesion.
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fig2
The crooked retinal arterioles and retinal venules extended into the outer nuclear layers of the macula of the right eye (Figure 2(a)). OCT showed that a dense epiretinal membrane was attached in the inner surface of the retina, hyperreflective materials were located at the level of the outer retinal layers, and vascularized PED was found in the macular fovea of the right eye (Figures 2(b) and 2(c)). Optical coherence tomography angiography (OCTA) detected abnormal vascular networks in the superficial, deep retinal capillary plexus/inner retina, outer retina, and choroidal layers (Figures 2(d)-2(f)). Fundus fluorescein angiography (FFA) showed that an intraretinal vascular complex was formed by retinal artery and retinal vein anastomosis in the macular, and a hyperfluorescent lesion was detected at the inferonasal peripheral retina of the right eye (Figures 2(g)-2(j)).
The deterioration of RAP in the right eye. (a) Inflammatory cells in the vitreous cavity disappeared and fundus can be seen clearly. (b) The central retinal thickness increased; intra- and subretinal fluid produced. (c) OCTA showed the area of abnormal vascular network in the inner retina (d) and outer retina (e), and choroid layers (f) were enlarged.
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fig3
Five months later, the inflammation was under control (Figure 3(a)), but her RAP was progressed and resulted in serious damage in her central vision. OCT showed that intra- and subretinal fluids were increased (Figures 3(b) and 3(c)). Areas of abnormal vascular network on OCTA were enlarged (Figures 3(d)-3(f)).
Comparation of lesions before and after the treatment of anti-VEGF. (a, b) The color fundus photograph of the right eye before and after treatment. (a) The lesions have obscure boundaries and are surrounded with hemorrhages. (b) The yellow-white lesions in the macular and inferonasal peripheral retina. Retina were well-demarcated and shrunk, hemorrhage was absorbed, and exudation around the optic nerve reduced significantly. (c, d) The OCT images of RAP before and after treatment: (c) intra- and subretinal fluids were increased; (d) sub- and intraretinal fluids were partly absorbed, and central retinal thickness was reduced from 841 mum to 690 mum.
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fig4
After three intravitreal injections of ranibizumab (once a month), the lesions shrunk compared to before the VEGF treatment (Figures 4(a) and 4(b)). OCT revealed that sub- and intraretinal fluids were partly absorbed than before in the right eye (Figures 4(c) and 4(d)).