PMC9218176_01
Multimodal imaging of both eyes at the initial examination. (A,D) Color fundus photographs showing arteriolar narrowing, cystoid macular edema (CME) and mid-peripheral bone-spicule-like pigmentations in both eyes, and tortuous and dilated superior temporal vein in the left eye. (B,E) Infrared fundus photographs showing CME in both eyes, and swelling of retinal nerve fiber layer in the left eye. (C,F) SD-OCT: central macular thickness (CMT) was 554 mum in the right eye and 831 um in the left eye.
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F1
Color fundus photography showed the arteriolar narrowing, CME and mid-peripheral hyperpigmentary spots in form of bone-spiculesand in both eyes (Figure 1), and the tortuous and dilated superior temporal vein in the left eye. Spectral Domain Optical coherence tomography (SD-OCT) (Spectralis OCT, Heidelberg Engineering, Germany), fundus fluorescein angiography (FFA; Heidelberg Retina Angiograph, Heidelberg Engineering, Germany) and visual field tests with Octopus 900 (TOP strategy) were also performed, as shown in Figures 1-3. SD-OCT scan showed that central macular thickness (CMT) was 554 mum in the right eye and 831 mum in the left eye (Figure 1).
FFA images at initial visit. (A) Cystoid macular edema (CME) in the right eye. (B-E) A significant filling delay of the main veins (especially the superior veins) and CME (red arrow) in the left eye.
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F2
Spectral Domain Optical coherence tomography (SD-OCT) (Spectralis OCT, Heidelberg Engineering, Germany), fundus fluorescein angiography (FFA; Heidelberg Retina Angiograph, Heidelberg Engineering, Germany) and visual field tests with Octopus 900 (TOP strategy) were also performed, as shown in Figures 1-3. FFA showed the normal arm-retinal arteria filling time (15.8 s) and a significant filling delay of the main veins (23.7 s) in the left eye, and CME in both eyes (Figure 2).
Standard automated perimetry test results of both eyes. (A) Peripheral visual field defects of both eyes at the initial examination. (B) One month after intravitreal aflibercept in the left eye, visual field of the left eye improved.
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F3
Spectral Domain Optical coherence tomography (SD-OCT) (Spectralis OCT, Heidelberg Engineering, Germany), fundus fluorescein angiography (FFA; Heidelberg Retina Angiograph, Heidelberg Engineering, Germany) and visual field tests with Octopus 900 (TOP strategy) were also performed, as shown in Figures 1-3. Moreover, the perimetry showed a noticeable tunnel vision in both eyes, especially in the left eye (Figure 3). OCT scan showed a significant decrease in CMT (247 mum) (Figure 4) and BCVA elevated to 20/400. One month after treatment, BCVA in the left eye elevated to 20/200, macular edema (ME) completely disappeared and the visual field (VF) also improved accordingly (Figures 3, 4).
SD-OCT images of both eyes after intravitreal injection of aflibercept in the left eye. (A,D) One month after treatment, CMT was 334 mum in the right eye and macular edema (ME) of the left eye completely disappeared. (C) One week after treatment, CMT was 247 mum in the left eye. (B,E) Three months after treatment, CMT was 490 mum in the right eye and ME of the left eye relapsed.
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F4
OCT scan showed a significant decrease in CMT (247 mum) (Figure 4) and BCVA elevated to 20/400. One month after treatment, BCVA in the left eye elevated to 20/200, macular edema (ME) completely disappeared and the visual field (VF) also improved accordingly (Figures 3, 4).