Fundus autofluorescence imaging in Valsalva retinopathy
Maryam Dourandeesh Langroudy1 *
- Eye Research Center, Department of Eye, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
Abstract: Fundus autofluorescence (FAF) is a non-invasive imaging technique that is widely used in the evaluation of several eye conditions such as retinal dystrophies. Lipofuscin and other fluorophores associated with the accumulation of fluid, blood, or melanolipofuscin granules contribute to autofluorescence. (1) It is important to know about different patterns of hypo and hyper autofluorescence and use them in the diagnosis of related ocular diseases. (2)
Although this imaging technique is mainly used in the evaluation of RPE integrity, changes in autofluorescence can be seen in cases other than RPE involvement. (2,3)
Here, we present a case with hyperautofluorescent lesion in the foveal area following coronavirus vaccination.
Methods: A 38-year-old presented to our clinic with a painless visual blurring of the left eye since twenty days ago following the coronavirus vaccine injection. The patients’ past ocular, past medical, and drug history was negative. The best-corrected visual acuity (BCVA) of the right eye was 20/20 and the left eye was finger count 1 m. Slit-lamp examination of both eyes was unremarkable, and intraocular pressure of each eye was 18 mm Hg. Fundus examination of the left eye revealed a yellow-white well- demarcated round lesion in the foveal area. ( Figure 1) which showed hyperautofluorescence on fundus autofluorescence (FAF) (Figre 2). Spectral-domain optical coherence tomography (SD-OCT) of the left eye showed hyperreflective lesion in the foveal area with posterior shadowing. (Figure 3)
Results: Figures 1-3
Conclusion: This patient had a hyperautofluorescent lesion in the macular area which corresponds to the yellow-white lesion observed in the fundus examination. The findings are compatible with a resolving sub-ILM and intraretinal hemorrhage (Valsalva retinopathy).
Recent retinal hemorrhage is hypoautofluorescent, because fresh blood has no autofluorescence. On the other hand devitalized yellowish hemorrhage is hyperautofluorescent. (3,4) It is stated that bilirubin, an endogenous fluorophore formed from hemoglobin degradation over time is the origin of hyperautofluorescence.(3) Bilirubin excitation occurs at 470 nm and emission at approximately 520 nm, therefore its autofluorescence can easily be detected by spectralis OCT with BluePeak system. (1,3)
