PMC3938496_01
(A) Fundus photograph at presentation showing optic disc edema, whitening and edema of the posterior pole, and a cherry red spot. (B) Increased signal in T2-weighted magnetic resonance imaging and enhancing with contrast in right optic nerve. (C-E) Fundus fluorescein angiogram showing capillary dropout area, minimal vascular and disc leakage.
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Fundus examinations revealed an edematous disc, retinal whitening and edema along the posterior pole, and the presence of a cherry red spot; no retinal infiltration or vitreous opacity was observed (Figure 1A). Staining of small vessels was observed in the late phase of the angiogram (Figure 1C-E). Minimal increased signal in T2-weighted magnetic resonance imaging and enhancing with contrast limited to the anterior part of the optic nerve could represent an inflammatory response to the ischemic process of the optic nerve head (Figure 1B).
(A) Full field electroretinogram (ERG) showing reduction of oscillatory potentials (OP) wave and b-wave amplitude in rod-specific, cone-specific, and maximal electroretinogram in the right eye. (B) Diminished waveform of multifocal electroretinogram in central area of the right eye. (C) Flash visual evoked potential (VEP) showing both amplitude reduction and delayed implicit time in the right eye.
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A multifocal electroretinogram (ERG) showed diminished waveform in the entire macular area (Figure 2B). ERG showed decreased b-wave amplitude of both rod and cone response and oscillatory potential wave. Electronegative ERG pattern was evidenced in maximal combined ERG that represented a generalized ischemic process, which involved mainly the inner retina layer (Figure 2A). The patient demonstrated decreased amplitude and increased latency in flash visual evoked potential (VEP), which is consistent with generalized involvement of the entire retina, not limited only to the posterior pole (Figure 2C).