A man in his 40s, who was a known smoker for 30 years and had lived with diabetes for the last 5 years, presented with decreased vision in his left eye for 5 days. The left eye had no light perception, a dilated pupil, extensive iris neovascularization, and an intraocular pressure of 11 mm Hg. Ophthalmoscopy results revealed macular whitening that surrounded a cherry-red spot, multiple nerve fiber layer infarcts, intraretinal hemorrhages, and wedge-shaped patches of retinal pigment epithelium atrophy in midperiphery (Figure, A). Fluorescein angiography showed disc leakage, macular capillary nonperfusion, and hyperfluorescence that corresponded to patches of retinal pigment epithelium atrophy that were consistent with the Amalric sign (Figure, B).1 His blood pressure was 128/90 mm Hg. Carotid Doppler imaging results showed plaques at the origin of the left internal carotid artery that were causing 90% to 100% stenosis. The patient received a diagnosis of ocular ischemic syndrome with peripheral choroidal and macular nonperfusion.
Kumar V, R K. Peripheral Choroidal and Macular Retinal Vascular Nonperfusion. JAMA Ophthalmol. 2017;135(7):e170677. doi:10.1001/jamaophthalmol.2017.0677