Author: ROCIO VEGA GONZALEZ (Spain)
Co-authors: Bachar Kudsieh, Ignacio Flores-Moreno, Iulia O. Pana, Esther Casado-Franca, Mariluz Puertas, José M. Ruiz-Moreno
Purpose
To report microvascular changes, detected by swept-source optical coherence tomography angiography (SS-OCTA), due to idiopathic neuroretinitis in a young patient both in the acute phase and one month later.
Setting/Venue
Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain.
Methods
A case report of a 28 year old patient diagnosed with idiopathic neuroretinitis. The patient underwent a comprehensive ophthalmological examination that included measurement of best-corrected visual acuity (BCVA), pupils’ function, visual field test, fluorescein angiography (FA), and OCT imaging with DRI-OCT Triton Swept-Source OCT (Triton, Topcon Corporation, Japan) including optic disc (OD) and macula centered OCTA scans, 3D disc and 3D wide disc scans, radial B-scans centered in optic disc and macula. Vessel density was evaluated quantitatively in the macular and peripapillary regions.
Results
At the initial presentation, BCVA on the right eye was counting fingers. No relative afferent pupillary defect was present. OCT B-scan showed OD edema, intraretinal fluid (IRF), and exudates in outer retinal plexiform layer as well as neurosensory detachment (NSD) both subfoveal and peripapillary. In SS-OCTA a decrease in the visibility of OD vascular network was observed. Consequently, the mean vessel density was quantitatively lower compared with the contralateral healthy eye. Nevertheless, cross-sectional B-scans with flow overlay showed high flow signal within OD vasculature in all layers. On macular SS-OCTA there was no vascular disturbance. One month later, BCVA on the right eye was 20/25 with a profound superotemporal paracentral scotoma in visual field. On OCT B-scan NSD, IRF, and OD edema were absent, instead, a focal thinning of nerve fiber layer (NFL) appeared inferotemporal to the OD. OD SS-OCTA revealed a focal area of capillary network impairment located inferotemporal to the OD at the superficial vascular plexus, specifically involving radial peripapillary capillary (RPC) network within the NFL. Vessel density was quantitatively lower and flow signal was decreased in the same area. These findings were supported by FA which confirmed a focal perfusion defect in early and late frames.
Conlusions
SS-OCTA is a rapid and non-invasive technique that has shown to be useful to characterize neuroretinitis. In the acute phase is able to detect a specific pattern with decreased visibility of vascular network and high flow signal in cross-sectional B-scans with flow overlay. Additionally, SS-OCTA allows the surveillance and detection of potential sequelae. In this case, a focal impairment of peripapillary microvasculature with vessel density and flow signal reduction was found, along with a symptomatic focal loss of FNL.
Financial Disclosure
None
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