OSLI Retina

October 2016

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972 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ B R I E F R E P O R T ■ Optical Coherence Tomography Angiography Imaging of Congenital Retinal Macrovessel Rohan Chawla, MD, FRCS(Glasg); Ravi Bypareddy, MD, DNB; Koushik Tripathy, MD, DNB; Satya Sudha Daggumili, MBBS; Ankit Singh Tomar, MBBS ABSTRACT: Congenital retinal macrovessels (CRM) are rarely reported, aberrant, large branches of reti- nal vessels that can be both arteries and veins; how- ever, they are more commonly veins that cross the horizontal raphe to either supply or drain the mac- ula. In this brief report, the authors discuss opti- cal coherence tomography angiography features of CRM in a 12-year-old male patient presenting with low visual acuity in the right eye since childhood. To the authors' knowledge, this is the first such re- port published in the literature. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:972-973.] Congenital retinal macrovessels (CRM) are aberrant, large branches of retinal vessels. These could be both arteries or veins but are more commonly veins that typically cross the horizontal raphe to either supply or drain the macula. 1 These vessels are not seen very fre- quently. Low visual acuity due to CRM may be a result of development of a serous macular detachment, hem- orrhage, exudation, or foveal cyst, or the mere presence of the aberrant vessel in the foveal area. 2,3 We report optical coherence tomography angiography (OCTA) features of CRM. A 12-year-old boy reported to us with low visual acuity in his right eye since childhood. He had no his- tory of trauma or any ocular surgery. There was no sig- nificant family history. On examination, best-corrected visual acuity (BCVA) was 0.47 logMAR in the right eye and 0 logMAR units in the left eye. Anterior segment of either eye was unremarkable. Fundus examination of the right eye revealed a normal optic disc with an aber- rant retinal macrovessel (Figure 1A) draining into the superotemporal major vascular arcade vein, crossing the horizontal raphe, and bypassing the fovea, sugges- tive of a CRM. Few stellate, fine, hard exudates form- ing an incomplete macular fan were also seen. Fundus of the left eye was normal. OCTA (DRI TRITON OCT; Topcon, Tokyo, Japan) imaging of the superficial retina of the right fundus clearly revealed the aberrant ves- sel (Figure 1B). It also beautifully demonstrated a dis- torted and smaller foveal avascular zone (FAZ). En face imaging of deeper layers also revealed the vessel due to shadowing and projection artefacts (Figure 2A). The B- scan OCT image showed a normal foveal contour with normal foveal thickness and absence of any cystoid macular edema (CME). Few hyperreflective dots in ganglion-nerve fiber layer with mild shadowing were also seen along the course of the aberrant vessel around the fovea (Figure 2B). Few additional hyperreflective dots were noted in the outer plexiform/inner nuclear layers, which are likely due to the hard exudates. The CRM in our case did not pass through the cen- ter of the fovea, and there was lack of CME on OCT, yet the BCVA of our patient was 0.47 logMAR. This is probably due to the distorted FAZ, which is demon- strated clearly on the OCTA images. Anisometropic amblyopia can be an another possi- ble cause for the low vision; however, axial length was similar in both eyes (21.80 mm). The refractive error was –0.5 diopters (D) of cylinder at 90° in right eye and +0.5 D spherical in left eye. To the best of our knowl- edge, this is the first report of OCTA features of a case of CRM. Based on the severity of aberrant retinal vascu- lature, Archer et al. have classified congenital vessels that exhibit arteriovenous communications in to three categories. 4 In Group 1, anomalous arteriovenous com- From the Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. Originally submitted June 4, 2016. Revision received June 30, 2016. Accept- ed for publication July 19, 2016. The authors report no relevant financial disclosures. Address correspondence to Ravi Bypareddy, MD, DNB, Room 488, 4th floor, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, 110029; email: raviaiims1@gmail.com. doi: 10.3928/23258160-20161004-14

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