OSLI Retina

July 2020

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418 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ I M A G E S I N O P H T H A L M O L O G Y ■ Retinal Arteriovenous Malformation Occlusion and Optic Nerve Drusen: Casuality or Causality? Marco Battista, MD; Maria Vittoria Cicinelli, MD; Rosangela Lattanzio, MD; Francesco Bandello, MD ABSTRACT: Multimodal imaging of an impending retinal vein occlusion in an arteriovenous malfor- mation associated with optic nerve drusen (OND) in a 16-year-old girl affected by Wyburn-Mason Syndrome. The authors seek to determine whether the association between the two entities has had an additive role in the acute retinal vascular event. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:418-419.] Retinal arteriovenous malformation (AVM) is a rare congenital vascular anomaly characterized by marked arterial and venous dilatation with an aber- rant-to-absent capillary bed. The presentation ranges from small anastomotic communications scarcely vis- ible on ophthalmoscopy to pronounced dilatations of the entire retinal vascular system. 1 We present a photo essay of a unilateral AVM in a 16-year-old girl associated with bilateral optic nerve drusen (OND), complicated with impending vein occlusion. Ultra-widefield retinography in the left eye (OS) showed macular macrovessels crossing the horizon- tal raphe and rare hemorrhages in the inferotemporal periphery (Figure 1A). The right eye (OD) featured no vascular anomalies. Fundus autofluorescence re- vealed hyperautofluorescence at the optic nerve head in both eyes (Figure 1B). Optical coherence tomogra- phy (OCT) showed irregularity in subfoveal ellipsoid zone and external limiting membrane OS, along with mild disorganization of inner retinal layers (Figure 1C). Ultra-widefield fluorescein angiography (UWFA) and OCT angiography showed engorged vascular loops, scattered microaneurysms, partially obliter- From the Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy. Originally submitted March 19, 2020. Revision received March 19, 2020. Accepted for publication May 8, 2020. Dr. Lattanzio is a consultant for Allergan and Sifi. Dr. Bandello is a consultant for Alcon, Alimera Sciences, Allergan, Farmila-Thea, Bayer Shering-Pharma, Bausch + Lomb, Genentech, Hoffmann-La-Roche, NovagaliPharma, Novartis, Sanofi-Aventis, Thrombogenics, and Zeiss. The remaining authors report no relevant financial disclosures. Address correspondence to Marco Battista, MD, Department of Ophthalmology, University Vita-Salute, Scientific Institute Ospedale San Raffaele, via Olgettina 60, Milan, Italy 20132; email: battista.marco@hsr.it. doi: 10.3928/23258160-20200702-08

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