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Ophthalmic Images
October 20, 2021

Widefield Swept-Source Optical Coherence Tomography Angiography of a “Polypoidal-Like” Retinal Arteriovenous Anastomosis in Proliferative Diabetic Retinopathy

Author Affiliations
  • 1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
JAMA Ophthalmol. 2021;139(10):e213859. doi:10.1001/jamaophthalmol.2021.3859

A 69-year-old man with a history of proliferative diabetic retinopathy in both eyes presented with retinal hemorrhages and a whitish boundary demarcating the arterioles (Figure, A, yellow arrowheads, right eye shown). His visual acuity was 20/400 OU. The right eye received several anti–vascular endothelial growth factor injections. En face widefield swept-source optical coherence tomography angiography (SS-OCTA; 15 × 15 mm) of the total retina showed extensive retinal capillary and arteriolar nonperfusion (Figure, B, yellow segmentation lines). The en face OCTA image revealed a tangled-vessel structure surrounded by retinal capillary and arteriolar nonperfusion (Figure, B, blue box). The “polypoidal-like” lesion served as a retinal arteriovenous anastomosis. Retinal arteriovenous shunts at the arteriovenous crossing and venous loops have been described,1,2 but the lesion shown here is reminiscent of the tangled-vessel appearance of a polypoidal lesion associated with polypoidal choroidal vasculopathy.3,4 The B-scan with flow corresponding to the blue line confirms that this tangled-vessel lesion is contained within the retina.

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