Authors: Yao Mudi, Liu Qian, Yan Biao
Corresponding author: Yan Biao, Email: yanbiao@sjtu.edu.cn
Published:2026-09-10
DOI:10.3760/cma.j.cn115989-20260403-00157
ABSTRACT
A 54-year-old male patient was referred for a choroidal hemangioma in the left eye, during which a fundus lesion in the right eye was incidentally detected. He had a 3-year history of hypertension. Color fundus photography of the right eye revealed myelinated nerve fibers (MNF) at the optic disc, along with tortuous and dilated inferior retinal veins, dot-and-blot hemorrhages, venous vascular sheathing, and collateral vessel formation, suggestive of long-standing branch retinal vein occlusion (BRVO). Fluorescein fundus angiography (FFA) showed blocked fluorescence caused by MNF, extensive non-perfusion areas, and fluorescein leakage from a neovascular membrane (NVM). Optical coherence tomography angiography (OCTA) and optical coherence tomography (OCT) confirmed a pathological neovascular membrane that broke through the internal limiting membrane and grew along the scaffold of the locally adherent posterior hyaloid. The patient was diagnosed with long-standing BRVO complicated by retinal neovascularization and MNF in the right eye. Retinal laser photocoagulation was performed for the non-perfusion area, and blood pressure control was advised. At the 1-year follow-up, the fundus remained stable with absorption of the previous neovascularization and hemorrhages, and no new hemorrhage or exudation was observed. This rare case of MNF combined with long-standing BRVO and secondary neovascularization highlights that multimodal imaging can overcome the physical masking of MNF and precisely delineate the ischemic area and the anatomical level of neovascularization. MNF plaques may serve as an anatomical basis that, together with systemic risk factors such as hypertension, contributes to the development and progression of BRVO. Multimodal fundus screening and early intervention are of significant clinical value in such patients.
KEYWORDS：
Branch retinal vein occlusion; Myelinated retinal nerve fibers; Retinal neovascularization; Multimodal imaging; Optical coherence tomography angiography; Laser photocoagulation
COPYRIGHTS:
Copyright by Chinese Medical Association
No content published by the journals of Chinese Medical Association may be reproduced or abridged without authorization. Please do not use or copy the layout and design of the journals without permission.
All articles published represent the opinions of the authors, and do not reflect the official policy of the Chinese Medical Association or the Editorial Board, unless this is clearly specified.
Authors Info & Affiliations
Yao Mudi
Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai 200080, China
Liu Qian
Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai 200080, China
Yan Biao
Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai 200080, China
Figures & Tables
Figure 1 Fundus photography before treatment in the right eye Myelinated retinal nerve fibers with milky white and feather-like edges were seen below the optic disc and on the nasal side. The retinal veins below were tortuously expanded, and spotted bleeding, local venous sheath and tortuous bypass collateral circulation vessel formation were seen A: Global view B: Local enlarged view
Figure 2 FFA image before treatment in the right eye Masked fluorescence caused by the myelinated retinal nerve fibers adjacent to the optic disc. A large non-perfusion area and multiple spots of fluorescence leakage were visible in the lower retina. In the late stage, the neovascular membrane showed obvious strong fluorescence A: Venous phase image B: Late stage image FFA: fundus fluorescein angiography
Figure 3 OCTA image before treatment in the right eye Abnormal new blood vessels in the superficial vascular network below the retina (yellow arrow), large area of non-perfusion area A: OCTA superficial vascular plexus en face image B: OCT image of corresponding en face structure
Figure 4 OCT image before treatment in the right eye a disorder in the retinal structure, with local adhesion of the posterior vitreous limiting membrane and new blood vessel shadows growing on the vitreous stent (white arrow) A: Near-infrared reflection fundus image, green line shows OCT scan position B: OCT B scan image at the corresponding position OCTA: optical coherence tomography angiography; OCT: optical coherence tomography
Figure 5 Fundus photography of the right eye one year after retinal laser photocoagulation Dense old laser spots under the retina, the focus was stable, and no new active bleeding was found in the original lesion area A: Global view B: Local enlarged view
References click to collapse
[1] Straatsma BR, Foos RY, Heckenlively JR, et al. Myelinated retinal nerve fibers[J]. Am J Ophthalmol, 1981, 91(1):25-38. DOI: 10.1016/0002-9394(81)90345-7.
[2] Leys AM, Leys MJ, Hooymans JM, et al. Myelinated nerve fibers and retinal vascular abnormalities[J]. Retina, 1996, 16(2):89-96. DOI: 10.1097/00006982-199616020-00001.
[3] Attia S, Pasa MS, Ahmed N, et al. Rare association of extensive myelinated retinal nerve fibers with vascular abnormalities and vitreous hemorrhage: A case report[J]. Am J Ophthalmol Case Rep, 2026, 41:102520. DOI: 10.1016/j.ajoc.2026.102520.
[4] Caramoy A, Fauser S, Kirchhof B, et al. Retinal vascular abnormalities associated with myelinated nerve fibers[J]. Retina, 2011, 31(6):1234-1235. DOI: 10.1097/IAE.0b013e31820f4dba.
[5] Panigrahi A, Shaikh N. Neovascularization beneath myelinated nerve fibres: a multimodal approach[J]. Eye (Lond), 2025, 39(Suppl 1):170. DOI: 10.1038/s41433-024-03262-3.
[6] Ledesma-Gil G, Essilfie J, Gupta R, et al. Presumed natural history of combined hamartoma of the retina and retinal pigment epithelium[J]. Ophthalmol Retina, 2021, 5(11):1156-1163. DOI: 10.1016/j.oret.2021.01.011.
[7] Zhang CX, Xu KF, Long Q, et al. En face swept-source optical coherence tomography (SS-OCT) and SS-OCT angiography findings of retinal astrocytic hamartomas in patients with tuberous sclerosis complex[J]. Front Med (Lausanne), 2025, 12:1575006. DOI: 10.3389/fmed.2025.1575006.
[8] Shields JA, Shields CL, Honavar SG, et al. Classification and management of Coats disease: the 2000 Proctor Lecture[J]. Am J Ophthalmol, 2001, 131(5):572-583. DOI: 10.1016/s0002-9394(01)00896-0.