PMC5016948_01
Preoperative fundus findings of the patient. a Fundus photograph of the right eye shows inferior exudative retinal detachment with subretinal exudation (fibrin) inferior to the macula. b Fundus photograph of the left eye shows pigmentary changes at the posterior pole consistent with diffuse retinal pigment epitheliopathy. c Fluorescein angiography (late phase) of the right eye reveals an annular zone of small hyper and hypofluorescent areas corresponding to the mottled appearance of the RPE with pooling of dye in the subretinal space. Most of the hyperfluorescent areas being window defects with few increasing in size and intensity with time suggest active leaks. A small focal leaking area of hyperfluorescence is also seen inferonasal to the disc. d Optical coherence tomography (OCT) of the right eye shows the neurosensory detachment at the fovea with some underlying hyperreflective material suggestive of fibrin and a pigment epithelial detachment (PED)
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Fig1
There was whitish subretinal exudation inferior to the macula (fibrin, Fig. 1a). The LE showed pigmentary changes at the posterior pole and multiple pigment epithelial detachments (PEDs) (Fig. 1b). Fluorescein angiography (FA) of the RE showed window defects at the posterior pole with leaks at the nasal part of the window defect and inferonasal to the optic disc (Fig. 1c). Optical coherence tomography (OCT) of the RE revealed subfoveal fluid with some underlying hyperreflective material suggestive of fibrin and a serous PED (Fig. 1d).
The right eye 4 months (a,b) and 2 years (c,d,e,f) after scleral resection. a Four months postoperatively, fundus photograph of the right eye shows total resolution of the exudative detachment with persisting diffuse retinal pigment epitheliopathy at the posterior pole. b Four months' follow-up OCT shows resolution of subretinal fluid and marked reduction in height of the PED with persistence of some of the hyperreflective subretinal fibrin. c The right fundus 2 years after surgery, revealing retinal pigment epithelial changes and the absence of subretinal fluid at the posterior pole. d OCT of the right eye at 2 years after surgery shows the absence of subretinal fluid in the right eye. e The FFA revealed a leopard spot like fluorescence inferiorly. f The mid-phase ICGA of the right eye showed a block fluorescence at the foveal center and small pin-point leaks superior to the optic disc
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Fig2
At 4 months, the vision was 6/60 and the exudative detachment had totally resolved (Fig. 2a). OCT revealed resolution of subretinal fluid and marked reduction in the height of the PED with persistence of some of the hyperreflective subretinal fibrin (Fig. 2b). The right eye had attached retina with a focal elevated pigmented area at the fovea surrounded by hypopigmentation (Fig. 2c). Few intraretinal cystoid spaces and a subretinal mound presumably due to fibrin were visible (Fig. 2d). The FFA revealed the absence of any active leak and leopard spot like fluorescence in the inferior retina reminiscent of previous retinal detachment (Fig. 2e). Small pinpoint leaks were visible superior to the disc (Fig. 2f).
Evaluation of the left eye at 2 years' follow-up. a The fundus of the left eye at 2-years follow-up. b The OCT of the left eye showed multiple PEDs. c The FFA of the left eye revealed mottled hyper- and hypofluorescence, and no definite focal leak was evident. d Early phase ICGA of the left eye showed inferiorly enlarged choroidal vessels and granular fluorescence at the posterior pole. e Mid-phase ICGA revealed increased choroidal permeability and few active pin point leaks (black arrowhead)
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Fig3
The left eye had retained 6/18 vision and showed RPE changes and subretinal yellowish deposits (Fig. 3a). The OCT showed PEDs temporal to the fovea; and nasal intraretinal cystoid spaces (Fig. 3b). The FFA of the left eye revealed areas of mottled hyper and hypofluorescence with broad areas of staining, but no definitive focal leak could be identified (Fig. 3c). ICGA (early phase) of the left eye showed patchy granular fluorescence at the posterior pole, and dilated large choroidal vessels inferior to the fovea (Fig. 3d). In the mid phase, few active pin point leaks were also evident (black arrowhead, Fig. 3e).