PMC5611380_01
(A) Right eye with normal appearance of the optic nerve and macula. (B) Left eye with optic nerve hyperemia, swollen, retinal folds, dilated veins, and arteries. (C) Right eye with normal appearance of the optic nerve and macula. (D) Left eye with normal aspect of the optic disk with retinal and macular folds.
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F1
The right eye had no abnormalities during fundus examination; however, the left optic disk had prominent hyperemia, blurred margins, swelling with retinal folds, dilated veins, and normal sized arteries (Figures 1A,B). Direct ophthalmoscopy of the right fundus revealed no abnormalities, while the left eye had retinal folds involving the macula; however, the optic disk appeared normal. (Figures 1C,D).
Humphrey visual field test at initial presentation of the right eye; left gray scale right pattern deviation with an inferior-nasal focal depression correlated to a marginal superior-temporal nonspecific scotoma (A). Left eye showed total depression (B). One month after initial presentation: right eye within normal limits (C); left eye with marked superior nasal step with enlargement of blind spot (D). Six months after initial presentation: right eye within normal limits (E). Left eye with some focal point depressed in pattern deviation (F).
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F2
Automated perimetry revealed the presence of a focalized inferior-nasal sector depression associated with a marginal superior temporal sector scotoma in the right eye and an extensive visual field defect in the left eye (Figures 2A,B). The patient also demonstrated improvement during visual field examination, with normal appearance in the right eye and marked superior nasal step and enlargement of the blind spot in the left eye (Figures 2C,D). Figures 2E,F. Furthermore, the patient had no extraocular manifestations.
Pathologic examination of a biopsy taken from the left gastrocnemius muscle which shows (A) a medium caliber artery with total occlusion due to thrombosis inducing fibrinoid necrosis. (B) Inflammatory infiltrate with predominance of polymorphonuclear cells, a few giant multinucleated cells, and fibrinoid deposits.
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F3
An excisional biopsy was performed within the next 14 h, which revealed the presence of an occluded medium caliber artery secondary to thrombosis caused by fibrinoid necrosis, an important inflammatory reaction with polymorphonuclear recruitment and no granulomatous lesions (Figure 3).
Correlation between the ganglion cell layer (GCL), retinal nerve fiber layer (RNFL), and visual field. Marked thinning of the superior and inferior temporal sectors on RNFL and GCL, which correlates with an inferior and superior scotoma on the visual field.
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F4
One year after the first ophthalmologic assessment, a study to compare the areas of macular ganglion cell and retinal nerve fiber layer (RNFL) was performed, which demonstrated a residual thinning of the macular ganglion cells and the nerve fiber layer of the retina, which correlated with the defect of the visual field (pattern deviation) (Figure 4).