PMC6489032_01
a, b Ultra-wide field retinal images show no significant finding in the right eye but show a pigmented fibrotic lesion inferior to the pale optic disc, generalized vessel attenuation, and retinal pigment epithelial (RPE) atrophy at mid-periphery in the left eye. c, d On fundus autofluorescence images, the right eye shows a hyperautofluorescent focus at the fovea, and the left eye shows diffuse hypoautofluorescence at the maculopapillary area. e, f On fluorescein angiogram, both eyes show peripheral vascular leakage in the late phase, and the left eye shows diffuse stippled hyperfluorescence corresponding to the RPE atrophy.
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F1
Funduscopic examination showed no significant finding in the right eye (Fig. 1a), but a pigmented fibrotic lesion inferior to the pale optic disc, generalized vessel attenuation, and retinal pigment epithelial (RPE) atrophy at mid-periphery were observed in the left eye (Fig. 1b). On fundus autofluorescence, the right eye showed a hyperautofluorescent focus at the fovea (Fig. 1c), and the left eye showed diffuse hypoautofluorescence at the maculopapillary area (Fig. 1d). On fluorescein angiogram, the left eye showed diffuse stippled hyperfluorescence corresponding to the RPE atrophy (Fig. 1f). Both eyes showed peripheral leakage in the late phase implicating vasculopathy, which was more prominent in the left eye (Fig. 1e, f).
Serial horizontal scans of spectral domain optical coherence tomography in both eyes. At 3 months after the injury (a, b), an impending macular hole with a very thin inner retinal layer was observed in the right eye and diffuse atrophic change with foveal thinning in the left eye. At 5 months after the injury (c, d), the outer retinal defect had decreased in the right eye. On the first visit at our clinic, 9 months after the injury (e, f), the impending macular hole was found to have regressed with only a focal defect in the ellipsoid zone with a visual acuity of 20/40. At the last follow-up, 18 months after the injury (g, h), there was improvement in ellipsoid zone integrity in the right eye, and visual acuity had improved to 20/33. However, diffuse retinal atrophy in the left eye had not recovered, and the final visual acuity was hand motion.
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F2
Spectral domain optical coherence tomography (OCT) examination revealed disruption and a focal defect in the ellipsoid zone in the right macula (Fig. 2e), and there was diffuse retinal atrophy in the left eye (Fig. 2f). OCT images performed at the outside hospital, the left eye image 3 months after the injury showed atrophic change comparable with the OCT image at our clinic (Fig. 2b), but the right eye showed an impending macular hole with a very thin inner retinal layer (Fig. 2a). On OCT image 5 months after the injury, the outer retinal defect in the right eye had decreased (Fig. 2c). There was further improvement in ellipsoid zone integrity on the OCT image of the right eye (Fig. 2g), and BCVA had improved to 20/32, while there was no change in the left eye (Fig. 2h).