PMC10155549_01
Color fundus photograph of right (a) and left eye (c) shows presence of microaneurysms, multiple dot hemorrhages (horizontal small arrow head) at the posterior pole along with localized microvascular telangiectasia (vertical long arrow head) distributed along terminal blood vessels temporal to the macula, features better appreciated using red-free imaging (b, d)
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Dilated fundus evaluation revealed localized microvascular telangiectasia distributed along the terminal blood vessels around the fovea and elsewhere in the macula with microaneurysms and multiple dot hemorrhages at the posterior pole in both the eyes [Fig. 1a and c]. The right eye also had ME and a small tortuous blood vessel with collaterals temporal to the fovea, which was better appreciated using red-free filter [Fig. 1b, 1d].
Fundus fluorescein angiography of the right (a) and the left eye (b); late-phase delineates the microaneurysms present in the posterior pole and temporal parafoveal telangiectatic blood vessels
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Fundus fluorescein angiography (FFA) revealed bilateral perifoveal capillary telangiectasia, pinpoint hyperfluorescence in early phase (microaneurysms) with late leakage, without neovascularization [Fig. 2a, 2b].
SS-OCT of the right eye macula (a) shows intraretinal hyporeflective spaces temporal to the fovea along with subfoveal neurosensory detachment; left eye (b) shows normal anatomical layers. At one-month follow-up post injection, right eye (c) shows disappearance of the subfoveal neurosensory detachment with the persistence of the intraretinal hyporeflective spaces; left eye (d) remains the same. After third injection, right eye (e) shows significant reduction of intraretinal hyporeflective spaces. At nine-month follow-up, right eye (f) shows huge intraretinal hyporeflective cystic spaces
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Swept-source optical coherence tomography (SS-OCT) of the right eye revealed a subfoveal neurosensory detachment (NSD) with pockets of intraretinal fluid temporal to the fovea, whereas SS-OCT was unremarkable for the left eye [Fig. 3a, 3b]. At one-month follow-up, vision improved to 20/20p in the right eye with OCT showing resolution of NSD, though there was persistence of intraretinal fluid [Fig. 3c, 3d]. Thereafter, two more doses of IVB were administered at one-month intervals, and significant resolution of ME was noted after the third dose [Fig. 3e]. OCT showed intraretinal cystic spaces and focal exudates in the affected eye [Fig. 3f].
OCTA image of the right eye superficial (a) and deep capillary plexus slab (b) reveals areas of capillary dropout with an enlarged FAZ, telangiectatic terminal blood vessel at the temporal border of the fovea, whereas that of the left eye shows a circular normal FAZ with areas of capillary dropouts temporal to it in the superficial capillary plexus slab (c) and telangiectatic blood vessels in deep (d) capillary plexus slab
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OCT angiography (OCTA) of both the eyes revealed abnormal telangiectatic vessels in superficial and deep retinal vasculature with capillary dropouts and irregular foveal avascular zone (FAZ) temporally [Fig. 4a-d].