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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 1  |  Page : 62-63

Anomalous aneurysmal vessel at the fovea


Retina Services, Neoretina Eye Care Institute, Hyderabad, Telangana, India

Date of Submission31-May-2020
Date of Acceptance07-Aug-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Dr. Anuj Sharma
Neoretina Eye Care Institute, Hyderabad - 500 001, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1747_20

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  Abstract 


Keywords: Aneurysmal vessel at the fovea, foveal neovascularization, vasoproliferative complex


How to cite this article:
Reddy RR, Sharma A. Anomalous aneurysmal vessel at the fovea. Indian J Ophthalmol Case Rep 2021;1:62-3

How to cite this URL:
Reddy RR, Sharma A. Anomalous aneurysmal vessel at the fovea. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Feb 26];1:62-3. Available from: https://www.ijoreports.in/text.asp?2021/1/1/62/305504



A 37-year-old, type II diabetic female, presented with complaints of diminished vision in both eyes since the past few months. The visual acuity was 20/60 in OD and 20/30 in OS. Fundus examination in OS [Figure 1]a showed neovascularization at the disc (NVD) and mild macular elevation suggesting macular edema. A note was made of an anomalous aneurysmal vessel at the temporal border of the fovea.
Figure 1: Fundus photograph (a) shows the presence of NVD along with the presence of laser marks compatible with PRP. A close up of the fovea shows the presence of the bulbous aneurysmal vessel at the temporal margin. FFA shows evidence of laminar flow in the aneurysmal vessel with vessel wall staining in the early phase (b) and the presence of leakage from these vessels in the late phase (c). A note is also made of the leakage from neovascularization at the disc and the temporal macula. Venular connections to this abnormal complex can also be traced in the early phase of the angiogram (b)

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Optical coherence tomography (OCT) revealed a bulbous projection from the inner retinal layers which penetrated the internal limiting membrane (ILM) and the posterior hyaloid to extend into the vitreous cavity [Figure 2]a and [Figure 2]b. OCT-angiography noted multiple knobby dilated vessels with a distortion of the foveal avascular zone, suggestive of ischemia [Figure 2]c; an increased blood flow was noted in the aneurysmal vessel [Figure 2]d. Laminar blood flow coupled with staining of the vessel wall, on Fundus Fluorescein Angiography (FFA), pointed towards a more venular origin of these anomalous vessels [Figure 1]b and [Figure 1]c.
Figure 2: OCT macula of the left eye (a and b) shows the presence of the cystoid macular edema, evidence of separation of the posterior hyaloid is noted with the anomalous vessel breaching the internal limiting membrane and the posterior hyaloid surface. OCT-angiography (c) noted multiple dilated aneurysmal blood vessels in the temporal fovea with a distortion of the foveal avascular zone. Knob-like termination of the perifoveal capillaries is noted suggestive of macular ischemia. Increased flow in the aneurysmal vessel is noted on the OCTA B-scan (d)

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The aneurysmal vessel did not show regression following pan-retinal photocoagulation. Further treatment in the form of anti- vascular endothelial growth factor (VEGF) agents was explained to the patient who declined the same citing good central vision as the reason for the same.


  Discussion Top


Neovascularization comprises new vessels that breach the internal limiting membrane and the posterior hyaloid.[1] The anomalous vessel reported in our case has characteristics resembling neovascularization elsewhere (NVE). The leakage on FFA is not typical of NVE while structurally it breaches the ILM and the posterior hyaloid as noted on OCT scans. On OCT-A the vessels can be seen to be originating from the superficial vascular plexus similar to the case reported by Andreanos et al.[2] Macular ischemia with neovascularization at the fovea was also described by Joondeph et al.[3] Miere et al. reported maturation of new vessels in choroidal neovascular membranes, wherein the new vessels acquire a coating of smooth muscle and tunica adventitia and are no longer dependent on VEGF for survival.[4] We propose that this aneurysmal vessel began as neovascularization but altered into a mature vessel following increased perfusion flow from the feeder vessels, resembling an abnormal vasoproliferative complex.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lee CS, Lee AY, Sim DA, Keane PA, Mehta H, Zarranz-Ventura J, Fruttiger M, et al. Reevaluating the definition of intraretinal microvascular abnormalities and neovascularization elsewhere in diabetic retinopathy using optical coherence tomography and fluorescein angiography. Am J Ophthalmol 2015;159:101-10.e1.  Back to cited text no. 1
    
2.
Andreanos K, Rostos T, Kymionis G, Koutsandrea C, Kotsolis A, Ladas I. Optical coherence tomography angiography of foveal neovascularization in diabetic retinopathy. Case Rep Ophthalmol 2018;9:87-91.  Back to cited text no. 2
    
3.
Joondeph BC, Joondeph HC, Flood TP. Foveal neovascularization in diabetic retinopathy. Arch Ophthalmol 1987;105:1672-5.  Back to cited text no. 3
    
4.
Miere A, Butori P, Cohen SY, Semoun O, Capuano V, Jung C, et al. Vascular remodeling of choroidal neovascularization after anti-vascular endothelial growth factor therapy visualized on optical coherence tomography angiography. Retina 2019;33:548-57.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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