case_images: PMC10550437_01
case_images: Composite fundus photograph depicting white vascular retinal lesions both in arteries and veins in the LE with a "cherry red spot" in macula.
case_images: CRIOPM2023-6698239.001.jpg
case_images: PMC10550437_01_CRIOPM2023-6698239.001.jpg
case_images: fig1
case_images: The white retinal aggregates were interrupted by blood filled vascular segments (Figure 1), and a "cherry red spot" was present in the macula (Figure 1).
case_images: Serial fundus photography of the LE taken with intervals of 0 seconds (a), 21 seconds (b), 25 seconds (c), and 35 seconds (d) starting from (a) through (d). Red blood cellular aggregates can be traced moving downstream the superior temporal branch of central retinal vein (insert).
case_images: CRIOPM2023-6698239.002.jpg
case_images: PMC10550437_01_CRIOPM2023-6698239.002.jpg
case_images: fig2
case_images: Fluorescein angiogram of the LE. Delayed choroidal filling at 20 seconds (a) followed by normal arterial phase 2 seconds later (b) and arteriovenous phase 11 seconds later (c). In the venous phase, 31 seconds later (d), arteriolar pruning with capillary dropout (arrowhead) and capillary bed leakage (asterisk) was noted. Microvascular pathology such as microaneurysms and intraretinal microvascular anomalies was ubiquitous.
case_images: CRIOPM2023-6698239.003.jpg
case_images: PMC10550437_01_CRIOPM2023-6698239.003.jpg
case_images: fig3
case_images: Fluorescein angiography (FA) of the LE showed delayed choroidal and retinal arteriovenous phase that was protracted but without blockage in the flow of dye in the lipid laden vessels (Figure 3). In the venous phase, there was capillary bed leakage and focal areas of capillary dropout (Figure 3(d)).
case_images: Near infrared image (a) shows hyperinfrared reflection from vascular aggregates in the affected vascular segments (arrowhead). Spectral domain OCT (Spectralis, Heidelberg Engineering ) (b) of the LE with a p-MLM (arrow) and hyperreflective inner retinal layers (asterisk).
case_images: CRIOPM2023-6698239.004.jpg
case_images: PMC10550437_01_CRIOPM2023-6698239.004.jpg
case_images: fig4
case_images: On OCT (Spectralis, Heidelberg Engineering ), there was linear hyperdensity at the level of deep capillary plexus on the inner side of outer plexiform layer, compatible with a prominent middle limiting membrane sign (p-MLM) (Figure 4). There was noted increased thickness of the choroid on OCT (subfoveal choroidal thickness of 452 mum) (Figure 4).
case_images: Fundus autofluorescence (Spectralis, Heidelberg Engineering ) of the LE, demonstrating increased autofluorescence at the observed white retinal vascular lesions (arrowhead).
case_images: CRIOPM2023-6698239.005.jpg
case_images: PMC10550437_01_CRIOPM2023-6698239.005.jpg
case_images: fig5
case_images: Composite fundus photograph of LE, one day after insulin and statin therapy initiation, showing resolution of the white vascular aggregates and persistence of the "cherry red spot" in macula.
case_images: CRIOPM2023-6698239.006.jpg
case_images: PMC10550437_01_CRIOPM2023-6698239.006.jpg
case_images: fig6
case_images: The patient was admitted to the department of Internal Medicine, Zealand University Hospital, and started on insulin and atorvastatin therapy with rapid elimination of the white lesions one day later (Figure 6).
case_images: Spectral domain OCT (Spectralis, Heidelberg Engineering ) of the LE two years later, presenting atrophy of the inner retinal layers at the macular area.
case_images: CRIOPM2023-6698239.007.jpg
case_images: PMC10550437_01_CRIOPM2023-6698239.007.jpg
case_images: fig7
case_images: Visual acuity at 5 weeks was 20/20 on the RE and 20/60 on the LE, and inner retinal layer thinning at the macula was evident (Figure 7).