PMC3206123_01
Initial presentation. Best corrected visual acuity 20/80. (A) Color fundus photograph demonstrates extensive, confluent inferior retinal hemorrhages with macular involvement. (B) Optical coherence tomography demonstrates intraretinal cysts and subretinal fluid. Central foveal thickness 696 microns (central 1 mm subfield). (C-E) Fluorescein angiography. (C) Early: 28 seconds, (D) 2.37 minutes, and (E) Late: 9.42 minutes, extensive blockage from hemorrhage and late hyperfluorescence.
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Fundus evaluation of the right eye was within normal limits, and the left eye demonstrated extensive, confluent intraretinal hemorrhages extending inferiorly from the nerve and involving the macula (Figure 1A). OCT of the right eye was unremarkable, and the left eye demonstrated intraretinal and subretinal fluid with a central retinal thickness of 696 microns (Figure 1B). Fluorescein angiography of the left eye showed blockage from hemorrhage, with subsequent limited assessment of perfusion and late hyperfluorescence (Figure 1C-E).
Cirrus spectral domain optical coherence tomography progression. (A) Best corrected visual acuity 20/60, improved intraretinal and subretinal fluid (central foveal thickness 534 microns) after initial intravitreal bevacizumab injection four weeks earlier. (B) Best corrected visual acuity 20/70, central foveal thickness 682 microns. (C) Color fundus photograph six weeks after third intravitreal bevacizumab injection. Improved confluent macular hemorrhage. (D) Best corrected visual acuity 20/40, central foveal thickness 473 microns, corresponding optical coherence tomography to (C) visit.
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At one month, visual acuity in the left eye improved to 20/60 and OCT demonstrated improved fluid with a central retinal thickness of 534 microns (Figure 2A). At the subsequent four-week visit, the patient was symptomatic with a decline in visual acuity to 20/70 and increased fluid was present on OCT (Figure 2B). Six weeks later, visual acuity improved to 20/40, the confluent macular hemorrhage had improved, and OCT showed reduced fluid (Figure 2C and D).
Recent follow-up. Best corrected visual acuity 20/25. (A) Color fundus photograph demonstrates resolution of majority of confluent hemorrhages. (B) Optical coherence tomography demonstrates resolved fluid (central foveal thickness 261 microns) and presence of subfoveal inner and outer segment disruption.
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At recent follow-up, six weeks after the last injection, visual acuity improved to 20/25 and fundus evaluation showed minimal intraretinal hemorrhages (Figure 3A). OCT demonstrated a preserved foveal contour with resolved fluid and subfoveal inner and outer segment (IS/OS) disruption (Figure 3B).