case_images: PMC8710488_01
case_images: Multimodal imaging at the initial visit. (A) Fundus examination of the left eye shows an isolated off-white lesion near the macular area and a large level of muddy-like exudate above the macular area. (B) An enlarged image of the lesion. (C) OCT imaging shows off-white lesions on transverse scanning; the lesions are bright on the outside and black on the inside with an oval ring reflection (bold green arrow), strong point reflection between layers, and edema between layers. (D) OCT-A shows sparse blood vessels, superficial vascular dilatation, and a tangled nodule beside the vessels. (E) Enlarged OCT-A image. (F,G) The fundus and OCT of the right eye are normal.
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case_images: PMC8710488_01_fmed-08-757313-g0001.jpg
case_images: F1
case_images: However, fundus examination of the left eye showed an isolated off-white lesion near the macular area and a large amount of muddy-like exudates above the macular area (Figure 1A). An enlarged image of the lesion (Figure 1B). OCT images showed off-white lesions in the cross-sectional scan that were bright around the edges and black on the inside, with an oval circular reflex, a strong point-like reflex and edema between the layers (Figure 1C). An OCT-A scan showed sparse blood vessels with dilated superficial blood vessels and an adjacent tangled nodule (Figure 1D). Enlarged OCT-A image (Figure 1E). The fundus and OCT of the right eye were normal (Figures 1F,G).
case_images: Fundus examination one month after intravitreal injection of anti-VEGF. (A) Fundus examination shows muddy-like exudation above the macular area, punctate hemorrhage, and no obvious change in the off-white lesions adjacent to the macula. (B) OCT-A shows sparse blood vessels, dilated superficial blood vessels, and a tangled nodule beside the blood vessels. (C,D) OCT imaging shows macular edema, dot-like hyperreflexia between layers, light on the outside and black on the inside, with no obvious change in oval structure (bold green arrow), and cystic edema in some parts of the macular area (bold green arrow). (E,F) FFA shows a strong fluorescent focus with a clear boundary near the macula in the early stage and obvious leakage in the later stage. (G,H) ICGA shows well-defined, strong fluorescence near the macula in the early stage, but no obvious leakage in the later stage. (I) The MPL treatment was delivered in a fan shape, covering the focus and the upper edema area.
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case_images: PMC8710488_01_fmed-08-757313-g0002.jpg
case_images: F2
case_images: One month after the injection, the following findings were observed, as shown in Figures 2A-H. The parameters were as follows, 577 nm, 160 mum, 300 mw, 0.2 s, duty cycle 5% and spacing 0 (Figure 2I).
case_images: One month after the second MPL treatment. (A) Fundus examination of the left eye shows muddy-like exudation above the macular area and that the off-white lesions had shrunken. (B) OCT shows that the oval structure in macular area had become more solid and that the cavity structure had disappeared. (C,D) FFA shows strong fluorescent light spots near the macular area in the early stage and slight leakage in the later stage. (E,F) ICGA shows a light spot near macular area in the early stage, and there was no leakage in the later stage.
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case_images: PMC8710488_01_fmed-08-757313-g0003.jpg
case_images: F3
case_images: One month after the second MPL treatment, examination of the left eye showed that the exudation and edema were significantly improved (Figures 3A-F).
case_images: Twenty-four months after MPL treatment. (A) Exudates are scattered above the macular area. (B) OCT-A shows sparse vessels in the upper arch ring and that the tumor-like dilatation had disappeared. (C) OCT shows that the tumor-like structure had disappeared, and there are a few punctate hyperreflections between the layers. (D) In the OCT comparison chart, the tumor-like structure had disappeared.
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case_images: PMC8710488_01_fmed-08-757313-g0004.jpg
case_images: F4
case_images: Examination of the left eye showed that the exudation and edema were significantly improved and that the lesions had disappeared (Figures 4A-D).