PMC6883378_01
Color fundus photo and spectral domain optical coherence tomography of the right and the left eye.. Colour fundus photo showing macular edema with hard exudates in the right eye (a), microaneurysms, RPE changes and a dull foveal reflex in the left eye (b). Horizontal spectral domain optical coherence tomography scan through the fovea revealed cystic changes with thickening of the fovea, hyperreflective dots corresponding to the hard exudates, and attenuation of the ellipsoid zone in the central and temporal parafoveal area of the right eye (c). In the left eye, spectral domain optical coherence tomography showed a central hyporeflective space in the outer retina with loss of the ellipsoid zone (d).
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F1
Fundoscopy of the right eye showed edema with hard exudates over the macula (Figure 1a (Fig. 1)). The macula of the left eye showed retinal pigment epithelial changes (Figure 1b (Fig. 1)). Spectral domain optical coherence tomography (Heidelberg Engineering Germany) of the right eye revealed cystic changes with thickening of the fovea, hyperreflective dots corresponding to the hard exudates, and attenuation of the ellipsoid zone in the central and temporal parafoveal area (Figure 1c (Fig. 1)). In the left eye, spectral domain optical coherence tomography showed a central hyporeflective space in the outer retina with loss of the ellipsoid zone (Figure 1d (Fig. 1)).
Multicolour composite images (MC) and blue reflectance images.. The MC image showed greenish hue inferior to the fovea (between arrows) and yellow dots corresponding to the hard exudates (a). In the left eye MC composite image, the microaneurysms were clearly seen as dark red dots (arrow) (b). In the blue reflectance image, increased parafoveal reflectance was seen in both eyes (closed arrows) (c,d). Additionally, in the right eye it showed a clear distinction between hyperreflective vessels in the inferior parafovea and the hyporeflective appearance of other vessels in the blue reflectance image image (open arrows).
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F2
MC imaging (Heidelberg Engineering, Heidelberg, Germany) of the right eye showed a greenish hue inferior to the fovea corresponding to foveal thickening on spectral domain optical coherence tomography and yellow dots corresponding to the hard exudates (Figure 2a (Fig. 2)). In the left eye, MC imaging showed the microaneurysms (Figure 2b (Fig. 2)). In the blue reflectance images, an increased parafoveal reflectance was seen in both eyes (Figure 2c,d (Fig. 2)).
Fundus Fluorescein angiography early (a,b) and late phase (c,d).. In the right eye, telangiectatic vessels in the temporal and inferior parafovea with few microaneurysms are seen in the early phase (a). In the left eye, microaneurysms in the parafoveal region are seen in the early phase (b). Late phase images show diffuse hyperfluorescence in the right eye (c) and mild staining of the temporal parafovea in the left eye (d).
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F3
Early phase fundus fluorescein angiography in the right eye showed telangiectatic vessels in the temporal and inferior parafovea with few microaneurysms and diffuse late phase hyperfluorescence that corresponded partly to the area of foveal thickening on optical coherence tomography and partly to the hyperreflective area on blue reflectance (Figure 3a,c (Fig. 3)). In the left eye, early phase fundus fluorescein angiography showed micoaneurysms in the parafoveal region and mild staining of the temporal parafovea in the late phase (Figure 3b,d (Fig. 3)). 
Horizontal spectral domain optical coherence tomography image through the fovea of the right eye one month after Ranibizumab therapy shows reduction of the central foveal thickness and complete resolution of the cystoid changes. Few hyperreflective dots corresponding to hard exudates are still seen and central loss of ellipsoid zone is seen centrally (between open arrows).
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F4
In addition, attenuation of the ellipsoid zone was seen (Figure 4 (Fig. 4)).