PMC8795594_01
Retinal fundus photographs before surgery showing mild venous dilation in the right eye (A) and the left eye (B).
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Fundus examination revealed mildly distended veins in both eyes ( Figure 1 ).
Baseline fundus fluorescein angiography (FFA). Left eye angiogram reveals (A) patchy choroidal filling and a prolonged arm-to-retina circulation time of 38 s. (B) Leading edge of fluorescein dye in the arteries. (C) Multiple microaneurysms in the midperipheral retina. (D) Diffuse dye leakage in the late phase with mildly dilated retinal veins. Right eye angiogram shows similar changes with (E) delayed arterial filling and (F) late-phase dye leakage.
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There was no evidence of capillary non-perfusion, arteriovenous shunts, or retinal neovascularization ( Figure 2 ).
Pre- and postoperative 3.0 * 3.0 mm optical coherence tomography angiography (OCTA) images. Superficial capillary plexus (SCP) in the right eye (A-C) and left eye (G-I) preoperatively and at two follow-up visits (1 and 6 months) illustrate a gradual increase of macular vessel density. Deep capillary plexus (DCP) in the right eye (D-F) and left eye (J-L) reveals similar vascular restoration, along with reconstruction of the perifoveal anastomotic capillary arcade. mo, month(s).
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OCT (SD-OCT) did not detect any significant macular changes. OCTA showed extreme rarefaction of perifoveal vascular density at the level of superficial capillary plexus (SCP) ( Figures 3A, G ) and deep capillary plexus (DCP) ( Figures 3D, J ) in both eyes. SCP ( Figures 3B, H ) and DCP layer ( Figures 3E, K ). She remained on tapered prednisone (35 mg/day), CTX (50 mg/day), vasodilator (40 mug twice daily), and aspirin. Notably, OCTA revealed further normalization of vascular density, along with restoration of perifoveal anastomotic capillary arcade ( Figures 3C, F, I, L ).
3D-reconstructed CT angiography (CTA) before balloon angioplasty shows complete occlusion of bilateral common carotid arteries (red arrows) and severe stenosis of bilateral proximal subclavian arteries (yellow arrowheads). Associated thrombi completely occluding bilateral common carotid arteries were also noted.
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A subsequent CT angiogram (CTA) disclosed circumferential thickening of thoracic aorta, complete occlusion of bilateral common carotid arteries, and critical stenosis of bilateral proximal subclavian arteries ( Figure 4 ).
Fundus fluorescein angiography (FFA) 6 months after balloon angioplasty. Left eye angiogram reveals (A, B) restoration of retinal blood flow (decreased arm-to-retina circulation time to 16 s) and (C) decrease of microaneurysms with less evident leakage in the late phase. (D) Right eye angiogram in the late phase shows similar improvement.
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Right eye angiogram showed similar improvement ( Figure 5 ).