case_images: PMC11250661_01
case_images: Imaging at presentation. Color fundus photos of the right (a) and left (b) eyes demonstrate bilateral posterior pole multiloculated subretinal fluid pockets. There is no evidence of disc edema, hyperemia, or any vascular sheathing, and the media is clear. Infrared images (c, d) better highlight the bilateral multiloculated pockets of subretinal fluid. Optical coherence tomography (e, f) of the macula showed a prominent accumulation of outer retinal and subretinal fluid, along with areas of bacillary layer detachments (BALAD, yellow arrows). Fluorescein angiography demonstrated scattered areas of leakage within the macula and multiloculated areas of pooling in both the right (g-i) and left (j-l) eyes. No leakage is noted from the optic discs or vessels.
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case_images: F1
case_images: There was no evidence of optic disc edema or hyperemia, nor any vascular sheathing (Fig. 1a-d). Optical coherence tomography (OCT) revealed bilateral bacillary layer detachments (BALAD, yellow arrows in Fig. 1e, f). On initial fluorescein angiography (FA), multiple areas of ink-blot leakage were observed in the posterior poles of both eyes, culminating in multiloculated areas of pooling (Fig. 1g-l).
case_images: OCT changes on day 5 compared to baseline. The left panels are diagrams showing the average change in retinal thickness (mum in black) and volume (mm3 in red) on day 5 compared to baseline for the right eye (a) and left eye (b). The right panels show macular maps of changes in retinal thickness for the right eye (a) and left eye (b). As shown by the color scale to the right, red represents thickening while green represents thinning compared to baseline.
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case_images: F2
case_images: OD and 20/200 OS). OCT showed decreased central fluid in the right eye, with some new foci of fluid nasally (Fig. 2a). The left eye showed a marked reduction in central thickness (Fig. 2b).
case_images: OCT and FA changes by 2 weeks after presentation. OCT imaging demonstrated a significant decrease in macular fluid on day 11 (a, b), which became more significant by day 14 (c, d). Fluorescein angiography of the right eye showed a reduction in macular leakage compared to baseline but also highlighted an isolated area of peripheral vascular staining in the right eye that was visible in the mid-phase (e, yellow arrow) and progressively leaked up to the late phase (f, yellow arrow).
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case_images: F3
case_images: At day 11 of follow-up, OCT showed definite improvement (Fig. 3a, b) with a marked decrease in macular fluid, which was even more evident on day 14 (Fig. 3c, d). Yet, to add to the clinical uncertainty, repeat FA on day 11 showed a small peripheral area of vascular leakage OD (Fig. 3e, f).
case_images: Imaging after the acute phase. a, b Optical coherence tomography of the macula at 1 month showed complete resolution of the macular fluid and bacillary layer detachments OU. Some residual ellipsoid zone, interdigitation zone, and RPE changes can be seen. c, d Color fundus photos showed resolution of the subretinal fluid blebs, but a new finding of white/yellow dots in the inferior midperiphery OU (yellow ovals). e, f By 3 months, these white dots had mostly resolved. g, h No recurrence of macular fluid was seen up to 7 months of follow-up on OCT. Some improvement of the ellipsoid changes was seen in both eyes.
case_images: cop-2024-0015-0001-538736_F04.jpg
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case_images: F4
case_images: While there were obvious ellipsoid zone and RPE changes, OCT showed complete resolution of the macular fluid (Fig. 4a, b). Interestingly, color fundus photos showed for the first time the presence of white spots in the inferior midperiphery OU (Fig. 4c, d). These spots disappeared 2 months later (Fig. 4e, f). At the most recent follow-up 7 months after initial presentation, the patient had regained 20/20 vision OU (Fig. 4g, h).