PMC3552475_01
Fundus photographs and fluorescein angiograms at initial examination showing bilateral diffuse perivascular sheathing and retinal edema with intraretinal hemorrhages (upper panel).. Note: Fluorescein angiography shows extensive vascular leakage and retinal edema (lower panel).
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Severe sheathing of the retinal vessels and retinal hemorrhages was detected in both eyes by ophthalmoscopy (Figure 1, upper panel). Fluorescein angiography showed perivenous staining and leakage from the vessels (Figure 1, lower panel).
Changes in spectral-domain optical coherence tomograms at onset, and at one week, one month, and 6 months after treatment.
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Spectral-domain optical coherence tomography (Spectralis , Heidelberg Engineering, Heidelberg, Germany) demonstrated severe macular edema with central macular thickness of 1045 mum OD and 991 mum OS (Figure 2, uppermost panel). Spectral-domain optical coherence tomography showed that the thickness of the retina was normal but the inner segment/outer segment junction of the photoreceptors was still disrupted at the fovea in both eyes (Figure 2, lowest panel).
Changes in full-field electroretinograms.. Notes: Full-field mixed rod and cone electroretinograms were recorded after 20 minutes of dark adaptation at onset and 6 months after treatment. Full-field electroretinograms were elicited by a contact lens electrode with a built-in white light emitting diode (LE-2000, Tomey Co, Nagoya, Japan). The stimulus intensity was 10.0 cd-s/m2 (photopic units). Although the a-waves and b-waves recovered to normal, the oscillatory potentials were still severely reduced at 6 months after onset.
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We also recorded full-field electroretinograms and found that the amplitudes of the mixed rod and cone responses after dark adaptation were severely attenuated in both eyes (Figure 3, middle panel). Full-field electroretinograms demonstrated nearly normal a waves and b waves, but severely reduced oscillatory potentials in both eyes (Figure 3, lowest panel).
Fundus photographs and fluorescein angiograms 6 months after treatment.. Note: The fundus had recovered to nearly normal, but the fluorescein angiograms show extensive lack of capillary perfusion in the peripheral retina (lower panel).
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Six months after the start of steroid therapy, best-corrected visual acuity was improved to 0.8 OD and 1.0 OS and the fundus had returned to nearly normal (Figure 4, upper panel). We performed fluorescein angiography again, and found that there were extensive areas without capillary perfusion in the periphery of both eyes (Figure 4, lower panel).