Microstructural Abnormalities Revealed by High Resolution Imaging Systems in Central Macular Arteriovenous Malformation.

Using high-resolution spectral-domain optical coherence tomography (SD-OCT) and adaptive optics (AO) imaging, photoreceptor damage in a patient with a central macular arteriovenous malformation (AVM) and otherwise unexplained progressive vision loss was demonstrated. This patient presented with a central scotoma, a macular AVM, and no evidence of macular edema, retinal hemorrhage, or subretinal fluid. Fluorescein angiography (FA) did not reveal leakage. Over 28 years, her vision progressively worsened from 20/25 to 20/400. Both time-domain OCT and FA did not reveal any significant retinal abnormality. However, high-resolution SD-OCT imaging revealed clear disorganization of the outer segments and focal photoreceptor disruption adjacent to the AVM. En face AO images further revealed loss of the photoreceptors in these regions. This case demonstrates the unique finding of progressive vision loss in a patient with a congenital retinal AVM, and how high-resolution imaging can detect structural changes of the retina in patients with otherwise unexplained vision loss.