OCT-A revealed reduced blood flow in both the inner and deep retinal vascular plexuses and a honeycomb-like hypointense signal pattern at the choriocapillaris layer. In addition, OCT revealed lesions of the hyperreflective band at the inner nuclear layer (INL) and on either side of the fovea corresponding to perifoveal wedge-shaped white-gray lesions, which is similar to paracentral acute middle maculopathy (PAMM).
OCT presented retinal thickening and oedema, especially at the inner layer. Fluorescence angiography (FA) indicated a slight delayed arteriovenous circulation time (14 s) and mottled hypofluorescence corresponding to cotton-wool spots and Purtscher flecken. The contralateral eye was almost normal except for mild arteriosclerosis. Dilated fundus examination revealed extensive spreading of cotton-wool spots confined to the peripapillary and posterior pole with slight retinal haemorrhage, as well as Purtscher flecken around the macular fovea in the right eye. Other signs of anterior segment and intraocular pressure were unremarkable. The affected right eye presented a positive result of relative afferent pupillary defect (RAPD) test. Ophthalmic inspections showed that the best-corrected visual acuity (BCVA) was hand movements in the right eye and 20/20 in the left eye. He reported neither trauma nor a special systemic medical history. A 65-year-old male presented to our clinical center with the chief complaint of acute onset of vision loss in the right eye for 2 weeks without a clear cause before the onset.
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