PMC3422150_01
Baseline fundus photographs (A and B) show a macular hole in the right eye and multiple soft drusen in both eyes. A full thickness macular hole is evident in the optical coherence tomography (C) of the right eye. Early (D) and Late (E) phase fluorescein and indocyanine green angiograms demonstrate a window defect.. Note: There is no evidence of choroidal neovascularization.. Abbreviation: FAG; Fluorecein angiogram.
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On fundus examination, multiple soft drusen were seen in the macula of both eyes (Figure 1A and B). In the right eye, a full-thickness macular hole was observed and was confirmed by optical coherence tomography (OCT) (Figure 1C). No evidence of CNV was found either in FAG or in indocyanine green (ICG) angiography (Figure 1D and E).
One month after the macular hole surgery. A fundus photograph of the right shows newly onset blot retinal hemorrhages (A). An optical coherence tomography image demonstrates dome-shaped retinal pigment epithelial detachment under the successfully sealed macular hole (B).
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One month after the surgery, fluid accumulation under the macula and multiple blot subretinal hemorrhages near the inferotemporal vascular arcade were observed (Figure 2A). OCT showed retinal pigment epithelial detachment (PED) under the successfully sealed macular hole (Figure 2B).
Two months after the macular hole surgery. Darker fluid accumulation is noted in the fundus photograph (A). Optical coherence tomography shows a decrease in height of the pigment epithelial detachment and wrinkling of the pigment epithelial layer (B). Hypofluorescent lines corresponding to the pigment epithelial wrinkles are evident in the angiogram (C and D). Note fine radiating choroidal neovascular network on early phase indocyanine green angiogram (C). Late phase angiogram shows multiple pinpoint leakages and pooling at the lesion (D).
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However, more opaque fluid accumulation and fine wrinkles under the macula were noted, obscuring the detail of the drusen at the region (Figure 3A). On OCT examination, reduction in the height of the PED and RPE layer wrinkling were noted (Figure 3B). FAG and ICG angiography showed distinct hypofluorescent lines at the macula throughout the study of the angiogram (Figure 3C and D). An early-phase ICG angiogram showed a radiating fine CNV network (Figure 3C). Late FAG pictures showed pinpoint leakages and pooling at the corresponding PED area (Figure 3D).
After 3 monthly intravitreal injection of ranibizumab. Fine wrinkles are more evident and some fibrotic changes are noted along the superotemporal and superonasal border of the lesion (A). An optical coherence tomographic finding did not change significantly compared to the previous image (B).
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The boundary of the lesion showed some fibrotic change along the superotemporal and superonasal border, and the subretinal wrinkles became more obvious (Figure 4A). OCT findings did not change significantly (Figure 4B).