PMC3716557_01
Findings in the left eye at the first visit: (A) the fundus photograph showed a wedge-shaped, dark reddish lesion at the macula (arrowheads), brush- or blotlike intraretinal hemorrhages that spread in a pandirectional manner from the optic disc, a mildly swollen optic disc, and dilated and tortuous retinal veins; (B) scanning laser ophthalmoscopy infrared imaging showed the dark area corresponding to the dark reddish lesion (arrowheads); (C and D) fluorescein angiography revealed hypofluorescence corresponding to the macular lesion (arrowheads) and retinal hemorrhages at the initial phase (C) and retinal phlebitis (arrowheads) and leakages from the optic disc in the late phase (D); (E) on indocyanine green angiography, the dark reddish lesion showed spotted hypofluorescence during the late phase (arrowheads); (F) Humphrey threshold 10-2 perimetry revealed a central scotoma (mean deviation value: -9.40dB); (G) optical coherence tomography showed the loss of the photoreceptor inner/outer segment junction corresponding to the macular lesion (arrows).
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Fundoscopic examination revealed a wedge-shaped, dark reddish-brown lesion at the macula, brush- or blot-like intraretinal hemorrhages that spread in a pandirectional manner from the optic disc, a mildly swollen optic disc, and dilatation and tortuosity of the retinal veins (Figure 1A). SLO infrared imaging revealed that the dark area corresponded to the dark reddish lesion (Figure 1B). Fluorescein angiography (FA) revealed hypofluorescence corresponding to the macular lesion and retinal hemorrhages in the initial phase (Figure 1C), and retinal phlebitis and the leakages from the optic disc in the late phase (Figure 1D). Indocyanine green angiography (ICGA) revealed a normal appearance during the initial phase, and spotted hypofluorescence at the macular area during the late phase (Figure 1E). Humphrey threshold 10-2 perimetry showed a central scotoma (mean deviation [MD] value: -9.40dB) corresponding to the lesion area (Figure 1F). OCT showed loss of the photoreceptor IS/OS corresponding to the dark reddish lesion (Figure 1G).
Photographs of the left eye 2 months after the first visit (A and B) and 2 weeks after corticosteroid pulse therapy (C-F): (A) fundus photograph showing the spontaneous absorption of the retinal hemorrhages, although the area of the macular lesion remained unchanged (arrowheads); (B) on late-phase fluorescein angiography, retinal phlebitis and the leakages from the optic disc resolved; (C) the dark reddish lesion improved; (D) the dark area on scanning laser ophthalmoscopy at the lesion site was reduced; (E) on perimetry, the central scotoma had shrunk (mean deviation value: -3.58dB); (F) on optical coherence tomography, the discontinuity of the photoreceptor inner/outer segment junction (arrows) had improved at the fovea.
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Two months after the first visit, the area of the macular lesion and BCVA remained almost unchanged, although most of the retinal hemorrhages spontaneously disappeared (Figure 2A), together with the resolution of retinal phlebitis and the leakages from the optic disc on late-phase FA (Figure 2B). The dark reddish-brown lesion had shrunk (Figure 2C), and the SLO dark area was reduced (Figure 2D). Humphrey perimetry showed that the central scotoma had shrunk, with marked improvement of MD value (-3.58dB) (Figure 2E), and that the discontinuity of the IS/OS at the macula had improved (Figure 2F).
Findings in the left eye 60 months after the first visit: (A and B) the dark reddish lesion (A) was faintly observed without a dark area on scanning laser ophthalmoscopy infrared imaging (B); (C and D) on late-phase fluorescein angiography (C) and indocyanine green angiography (D), hypofluorescent lesions corresponding to the acute macular neuroretinopathy lesion almost resolved; (E) optical coherence tomography revealed complete recovery of the inner/outer segment junction with partial discontinuity of the cone outer segment tip line (arrows).
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The dark reddish lesion was faintly observed without a dark area on SLO infrared imaging (Figure 3A and B). Late-phase FA and ICGA showed resolution of the hypofluorescent lesions at the macula (Figure 3C and D). OCT revealed complete recovery of the IS/OS, with partial discontinuity of the cone outer segment tip line (Figure 3E, arrows).