PMC8260843_01
Fundus photograph, FFA and SD-OCT of the right eye. (A,B) Funduscopic examination revealed retinal edema, intraretinal hemorrhage, elschnig spots (white arrow and red arrows), hard exudates and cotton-wool spots (black arrows) in right eye. (C) FFA showed the delayed choroidal filling regarding areas of capillary nonperfusion. (C-F) FFA showed multifocal sites of patchy hyperfluorescence in the early phase, with leakage during the entire imaging process describing elschnig spots, and blockage from the cotton wool spots. (G,H) SD-OCT showed the IRF (red arrows), SRD (green arrows) with multilayered hyperreflective lesions indicating fibrinous materials, swelling of RNFL, and thinner and disorganisation of the EZ and RPE (red rectangles).
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F1
Funduscopic examination revealed retinal oedema, intraretinal hemorrhage, elschnig spots, hard exudates, and cotton-wool spots in both eyes (Figures 1, 2A,B). FFA showed delayed choroidal filling in areas of capillary nonperfusion (Figure 1C). FFA also showed multifocal sites of patchy hyperfluorescence in the early phase, with leakage during the entire imaging process describing elschnig spots, and blockage from the cotton-wool spots (Figures 1, 2C-F). Spectral-domain optical coherence tomographic (SD-OCT) showed intraretinal fluid (IRF), serous retinal detachment (SRD) with multilayered hyperreflective lesions indicating fibrinous materials, swelling of the retinal nerve fiber layer (RNFL), disorganization of the ellipsoid zone (EZ), and retinal pigment epithelium (RPE) in the right eye (Figures 1G,H).
Fundus photograph, FFA and SD-OCT of the left eye. (A,B) Funduscopic examination revealed retinal oedema, intraretinal haemorrhage, elschnig spots (red arrows), hard exudates and cotton-wool spots (black arrows) in left eye. (C-F) FFA showed multifocal sites of patchy hyperfluorescence in the early phase, with leakage during the entire imaging process describing elschnig spots, and blockage from the cotton wool spots. (G,H) SD-OCT showed the IRF (red arrows) with multilayered hyperreflective lesions, swelling of RNFL and relatively preservation of the EZ and RPE were observed.
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F2
Funduscopic examination revealed retinal oedema, intraretinal hemorrhage, elschnig spots, hard exudates, and cotton-wool spots in both eyes (Figures 1, 2A,B). FFA also showed multifocal sites of patchy hyperfluorescence in the early phase, with leakage during the entire imaging process describing elschnig spots, and blockage from the cotton-wool spots (Figures 1, 2C-F). IRF with multilayered hyperreflective lesions, RNFL swelling, and relatively preserved EZ and RPE were observed in the left eye (Figures 2G,H).
Fundus photograph, and SD-OCT of the right eye during the follow-up. (A,D) 1 week follow-up, the IRF (red arrow) and SRD (green arrow) were reduced remarkably. (B,E) 1 month follow-up showed that the IRF and SRD were entirely resolved, however, the unusually punctate hyperreflection foci on the RPE level were still observed in the right eye's macula by SD-OCT (red rectangle), indicating a previous elschnig spot (white arrow in Figure 1A and red arrows in Figures 1D-F) and stellate exudates were observed in the right eye's macula. (C,F) At the most recent follow-up, after 4 months, the fundus condition was further improved, however, interruption and disorganisation of the EZ and RPE on SD-OCT (red rectangles) and hard exudates were observed in the right eye's macula.
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F3
During the 1-month follow-up period, the IRF and SRD were entirely resolved (Figures 3, 4B,E). However, the unusually punctate hyperreflection foci on the RPE level were still observed in the right eye's macula by SD-OCT, indicating a previous elschnig spot (shown on fundus photography and FFA) and stellate exudates were observed in the right eye's macula (Figures 3B,E). Four months later, during her most recent follow-up, the patient showed improvement of the fundus condition (Figures 3, 4C). However, interruption and disorganization of the EZ and RPE on SD-OCT and hard exudates were observed in the right eye's macula (Figures 3C,F).
Fundus photograph, and SD-OCT of the left eye during the follow-up. (A,D) 1 week follow-up, the IRF (red arrow) and SRD were reduced remarkably. (B,E) 1 month follow-up showed that the IRF and SRD were completely resolved. (C,F) At the most recent follow-up, after 4 months, the fundus appeared basically normal.
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F4
During the 1-month follow-up period, the IRF and SRD were entirely resolved (Figures 3, 4B,E). Four months later, during her most recent follow-up, the patient showed improvement of the fundus condition (Figures 3, 4C). The fundus appeared normal in the left eye (Figures 4C,F) and the BCVA then improved to 20/20 in both eyes.