PMC10328102_01
Fundus images of the left eye in case 1. Fundus photography (A) and fundus autofluorescence (B) were normal. OCT disclosed hyper-reflective segments of OPL and ONL, and associated disruption of ellipsoid, interdigitation zones, and RPE layers on the nasal macular area ((C), red box). No flow defects were observed in the superficial (D)/intermediate (E)/deep (F) retinal capillary plexuses and choroidal capillary plexus (G) on OCTA. One week after oral prednisone administration OPL and ONL hyper-reflectivity mildly faded with definable ellipsoid, interdigitation zones, and retinal pigment epithelium (RPE) layers ((H), red box). Six weeks later only slight irregularity of ellipsoid, interdigitation zones and RPE layers persisted on OCT ((I), red box).
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Fundus photography and autofluorescence (FAF) (Optos, Daytona Plus 200tx) did not reveal pathological changes (Figure 1A and B). There was also associated disruption of ellipsoid, interdigitation zones, and retinal pigment epithelium (RPE) layers on the nasal macula, corresponding with the temporal scotoma (Figure 1C). Optical coherence tomography angiography (OCTA, VG200S; SVision Imaging, Henan, China) showed no flow defects either in the superficial/intermediate/deep retinal capillary plexuses or in the choroidal capillary plexus (Figure 1D-G). One week later, the patient returned without obvious alleviation of the scotoma, but hyper-reflectivity of the OPL and ONL mildly faded with definable ellipsoid, interdigitation zones, and RPE layers (Figure 1H). Six weeks later, OCT only showed slight irregularity of ellipsoid, interdigitation zones, and retinal pigment epithelium (RPE) layers, but the patient still complained of slight scotoma (Figure 1I).
PMC10328102_02
Fundus images of the left eye in case 2. Fundus photography (A) was normal. OCT disclosed hyper-reflective segment of OPL and ONL, and associated disruption of ellipsoid, interdigitation zones, and RPE layers on the nasal ((B), red box) and upper macular ((C), red box). No flow defects in the superficial (D)/intermediate (E)/deep (F) retinal capillary plexuses and choroidal capillary plexus (G) on OCTA. Three weeks after oral prednisone administration, hyper-reflectivity of the OPL and ONL completely faded with definable ellipsoid, interdigitation zones, and RPE layers both on the nasal ((H), red box) and upper ((I), red box) macular on OCT. Six weeks later only slight irregularity of ellipsoid, interdigitation zones, and RPE layers persisted on OCT, on the nasal ((J), red box) and upper ((K), red box) macular areas.
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Fundus photography (Optos, Daytona Plus 200tx) did not indicate abnormalities (Figure 2A). OPL and ONL and associated disruption of ellipsoid, interdigitation zones, and RPE layers, on the nasal and upper macular areas (Figure 2B and C). OCTA (VG200S; SVision Imaging, Henan, China) showed no flow defect either in the superficial/intermediate/deep retinal capillary plexuses or in the choroidal capillary plexus (Figure 2D-G). Hyper-reflectivity of the OPL and ONL completely faded with definable ellipsoid, interdigitation zones, and RPE layers both on the nasal and upper macular areas (Figure 2H and I). Six weeks later, the patient still complained of a slightly blurred vision, and OCT showed a slight irregularity in the ellipsoid, interdigitation zones, and RPE layers (Figure 2J and K).
PMC10328102_03
Fundus images of the left eye in case 3. Fundus photography (A) was normal. A para-foveal hyper-reflective segment of the OPL and ONL, with associated disruption of ellipsoid, interdigitation zones, and RPE layers on OCT ((B), red box). No flow defects in the superficial (C)/intermediate (D)/deep (E) retinal capillary plexuses and choroidal capillary plexus (F) on OCTA. Three days after oral prednisone administration, hyper-reflectivity of the OPL and ONL mildly faded on OCT ((G), red box). Ten days later, hyper-reflectivity faded with definable ellipsoid, interdigitation zones, and RPE layers on the OCT ((H), red box). A tiny segmental discontinuity of ellipsoid, interdigitation zones, and RPE layers persisted on OCT at the 4-week visit ((I), red box) and 7-week visit ((J), red box).
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OCT (VG200S; SVision Imaging, Henan, China) showed a para-foveal hyper-reflective segment of the OPL and ONL with associated disruption of ellipsoid, interdigitation zones, and RPE layers (Figure 3B). OCTA (VG200S; SVision Imaging, Henan, China) showed no flow defect either in the superficial/intermediate/deep retinal capillary plexuses or in the choroidal capillary plexus (Figure 3C-F). Three days later, OCT indicated that OPL and ONL hyper-reflectivity had mildly faded (Figure 3G). Ten days later, OPL and ONL hyper-reflectivity had decreased further with definable ellipsoid, interdigitation zones, and RPE layers on the OCT (Figure 3H); however, the patient still complained of slight scotoma. During follow-up, the patient still complained of a subtle scotoma and OCT only showed a tiny segmental discontinuity of ellipsoid, interdigitation zones, and RPE layers at the 4-week visit and 7-week visit (Figure 3I and J).
PMC10328102_04
Fundus images of both eyes in case 4. Initial fundus photography revealed white-yellow lesions in the posterior retina in both eyes (Right: (A), Left: (B), photocopy from local records). The 30-2 visual field test showed visual defects on nasal and temporal fields in the right eye (C), while it was normal in the left eye ((D), photocopy from local records). At presentation, fundus photography showed reduced white-yellow lesions (Right: (E), Left: (F)) and OCT scan disclosed hyper-reflective segment of the OPL and ONL in the fovea of both eyes, also with associated disruption of ellipsoid, interdigitation zones, and RPE layers (Right: (G), Left: (H), red box). OCTA showed perfusion defects in the superficial (I and L)/deep (J and M) retinal capillary plexuses, also in the choroidal capillary plexus (K and N) on wide field OCTA in both eyes (Right: (I-K). Left: (L-N), yellow circle). Hyper-reflectivity of the OPL and ONL slightly faded (Right: (O), Left: (P), red box) one week after oral prednisone administration, as observed in OCT. Superficial (Q and T)/deep (R and U) retinal capillary defects, and choroidal (S and V) capillary defects slightly resolved on OCTA (Right: (Q-S). Left: (T-V), yellow circle).
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Fundus photography disclosed white-yellow lesions in the posterior retina (Figure 4A and B, photocopy from local records); however, the OCT scan was not available. A 30-2 visual field test on the right eye showed defects on nasal and temporal fields but was normal in the left eye (Figure 4C and D, photocopy from local records). OCT scan (VG200S; SVision Imaging, Henan, China) disclosed hyper-reflective segments of OPL and ONL in the fovea of both eyes, also with associated disruption of ellipsoid, interdigitation zones, and RPE layers (Figure 4G and H). OCTA (VG200S; SVision Imaging, Henan, China) showed perfusion defects in the superficial/deep retinal capillary plexuses, also in the choroidal capillary plexus on wide field OCTA in both eyes (Figure 4I-N). OCT showed that hyper-reflectivity of the OPL and ONL slightly faded (Figure 4O and P) and retinal capillary defects resolved on OCTA (Figure 4Q-V).