PMC3155274_01
Clinical findings for Case 1. Fundus photographs and fluorescent angiograms before treatment. There are many cotton wool patches surrounding the optic disc and retinal whitening surrounding the fovea (A). Fluorescein angiography shows nonperfused areas of retinal arterioles in the areas corresponding to the areas of cotton wool patches. A delay in the choroidal filling in the nasal area and arm-to-retina time (32 seconds) was found (B). Fundus photograph (C) and fluorescent angiogram (D) after treatment. Optic disc is slightly pale, and defects of the nerve fiber layer can be seen (C). Fluorescein angiography shows improvement of the retinal circulation (D). Arm-to-retina time was 15 seconds. Goldmann kinetic perimetry before (E) and after (F) treatment. There is a large absolute scotoma in the lower nasal field and paracentral scotoma before treatment (E). The paracentral scotoma is decreased after treatment (F).. Note: Black indicates absolute scotoma and gray relative scotoma in E and F.. Abbreviation: SC, scotoma.
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Fundus examination revealed multiple cotton wool patches surrounding the optic disc and retinal whitening in the macular area of the right eye (Figure 1A). Goldmann perimetry showed a paracentral scotoma and a large absolute scotoma in the lower nasal field (Figure 1E). The areas of occlusion of the retinal arterioles corresponded to the areas where the cotton wool patches were found (Figure 1B). There were no plaques in the arteries or apparent spasm of the retinal vessels (Figure 1B).
PMC3155274_02
Clinical findings for Case 2. Fundus photographs and fluorescein angiograms before treatment. There are many cotton wool patches surrounding the optic disc and retinal whitening surrounding the fovea (A). Fluorescein angiography showed nonperfused areas of retinal arterioles in areas corresponding to the cotton wool patches. The arm-to-retina time was 28 seconds (B). Humphrey static perimetry at onset (C) and 1 month later (F). Paracentral scotomas are almost gone. Fundus photograph 1 month after the onset (E). Most of the cotton wool patches and retinal whitening have disappeared. Optical coherence tomography at onset (D) and 1 month later (G). Swelling of the inner retina showing hyper-reflectivity was found at onset (D), but the hyper-reflectivity has disappeared and retinal thickness returned to normal 1 month after onset (G).
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Fundus examination showed multiple cotton wool patches surrounding the optic disc and slight retinal whitening around the fovea of the left eye (Figure 2A). Fluorescein angiography showed that the arm-to-retina circulation time was 23 seconds, and the areas of occluded retinal capillaries corresponded to the areas of the cotton wool patches (Figure 2B). Humphrey static perimetry showed several paracentral scotomas (Figure 2C), and optical coherence tomography (Stratus OCT 3000, Humphrey Zeiss) showed a slight thickening of the inner retina but not the retinal ganglion cell layer due to edematous changes (Figure 2D). Three weeks later, the cotton wool patches and retinal whitening disappeared without any medication (Figure 2E), and the thickness of the inner retinal layers was within the normal range in the optical coherence tomography images (Figure 2G). The Humphrey field analyzer findings improved and most of the scotomas were resolved (Figure 2F).
PMC3155274_03
Clinical findings for Case 3. Fundus photographs and fluorescein angiograms before treatment. There are many cotton wool patches surrounding the optic disc and slight retinal whitening surrounding the fovea (A). Fluorescein angiography showing that nonperfused areas of the retinal arterioles were found in the areas corresponding to the cotton wool patches. The delay in choroidal filling in the nasal area and arm-to-retina time (28 seconds) were found (B). Goldmann kinetic perimetry before (C) and 6 weeks after (D) treatment. There is a central scotoma and a constriction in lower nasal field and paracentral scotoma before treatment (C). Central scotoma is decreased and the constriction of lower nasal field has abated after treatment (D). Fundus photograph (C) and fluorescein angiogram (D) 6 weeks after treatment. Cotton wool patches are not present and optic disc is slightly pale (E). Fluorescein angiography showed improvement of retinal circulation 38 seconds after the injection of fluorescein (D).. Note: Black indicates absolute scotoma and gray relative scotoma in C and D.. Abbreviation: SC, scotoma.
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Fundus examination showed cotton wool patches surrounding the optic disc and slight retinal whitening in the macular area (Figure 3A). Fluorescein angiography showed that the arm-to-retina circulation time was 28 seconds, and the choroidal circulation to the nasal retina was delayed (Figure 3B). Goldmann kinetic perimetry showed a central scotoma and a defect in the lower nasal field (Figure 3C). The central scotoma and lower nasal field defect were almost gone (Figure 3D). Repeat fluorescein angiography showed a marked improvement in both retinal and choroid circulations (Figure 3E and F).