A type 2 diabetic patient who was diagnosed with AMD in both eyes and BRVO (after PRP) in the left eye complained of more severe vision loss recently.  Ultra-wide-field (UWF) color fundus images revealed abnormal yellow and white lesions at the macular in both eyes (fig.1 color fundus) and panretinal laser spots in his left eye. A small area of intraretinal hemorrhage was also noticed in the superior nasal quadrant of his left eye (fig.2 color fundus).

FFA of the right eye showed fluorescent leakage at the macular while OCT angiography revealed CNV in the leakage area. OCT image of the corresponding area revealed PVD, macular atrophy, and PED indicating the existence of CNV (fig.1).

FFA of the left eye showed a non-perfusion area in the superotemporal quadrant with several microaneurysms and severe fluorescent leakage at the macular. No peripheral information could be achieved with the limited field of view of FFA. In contrast, UWF full-range OCTA revealed clearly the details of non-perfusion areas, microvascular abnormalities in the SVC slab, and neovascularization in the vitreous slab (fig.2 circle & gif). Ultra-wide B scan showed how the neovascularization grew into the vitreous (fig.2 arrow).

A 400kHz speed UWF full-range swept-source OCTA (BMizar, TowardPi Medical) was used in this case to visualize details of vascular alterations in each slab. 120° ultra-wide-field of fundus can be achieved by one scan in 7-15 seconds.

Case courtesy of: Prof. Xueying Ma from Lanzhou Bright Eye Hospital.

Editor: Dr. Chloe Li, TowardPiMedical