PMC9792245_01
Fundal photos of the right and left eyes on presentation demonstrating intraretinal haemorrhages, cotton wool spots and Purtscher flecken with the characteristic clear zone between the lesions and the blood vessels.
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Both maculae were surrounded by small patches of retinal pallor, cotton wool spots, and intraretinal haemorrhages were observed across the posterior pole and mid-periphery in both eyes (Figure 1).
OCT B-scan at presentation demonstrating inner nuclear layer hyperreflectivity at the macula suggestive of paracentral acute middle maculopathy.
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Optical coherence tomography (OCT) revealed bilateral hyperreflective patches at the level of the inner nuclear layer suggestive of paracentral acute middle maculopathy (Figure 2).
Fluorescein angiography of the right eye at presentation. One can observe the enlarged foveal avascular zone and patchy hypofluorescence in the early phases which suggest that the choroid is also involved in PLR.
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Fluorescein angiography revealed an enlarged foveal avascular zone as well as early patchy hyperfluorescence (Figures 3 and 4).
Fluorescein angiography of the left eye at presentation.
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Fluorescein angiography revealed an enlarged foveal avascular zone as well as early patchy hyperfluorescence (Figures 3 and 4).
Fundal photos of the right and the left eyes 1-week postpresentation.
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There was an increase in intraretinal haemorrhages and macular oedema on repeat fundoscopy (Figures 5-7).
Fundal photo and OCT of the right eye 1-month postpresentation.
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There was an increase in intraretinal haemorrhages and macular oedema on repeat fundoscopy (Figures 5-7).
Fundal photo and OCT of the left eye 1-month postpresentation. An increase in cotton wool spots, intraretinal haemorrhages, and Purtscher's flecken was noted along with macular oedema which was confirmed on OCT.
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There was an increase in intraretinal haemorrhages and macular oedema on repeat fundoscopy (Figures 5-7).
Fundal photo of the right eye 6-month postpresentation. Note: the florid NVD and inferior-lying preretinal haemorrhage.
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fig8
On fundoscopy of the right eye, one could observe a thickened posterior hyaloid and an extensive preretinal bleed which was obstructing the posterior pole view associated with a florid fibrovascular NVD (Figure 8) while in the left eye, there was a preretinal haemorrhage inferiorly as well as similar NVD plexus.