Multimodal imaging of membranoproliferative glomerulonephritis type II

Abstract

To report the fundus findings on multimodal imaging of a membranoproliferative glomerulonephritis type II (MPGNII) patient. A 41-year-old woman had a medical history of renal transplantation for MPGNII 5 years prior to presentation to our clinic for ophthalmic examination. Fundus examination showed macular retinal pigment epithelial changes and large peripapillary atrophy in the right eye, and yellowish bilateral drusen-like deposits peripherally. Fundus fluorescein angiography and indocyanine green angiography revealed multifocal hyperfluorescence in the peripheral retina with accompanying deposits. A hyperautofluorescence pattern was seen in the fundus autofluorescence (FAF) images of the deposits. Spectral domain optical coherence tomography (SD-OCT) scans of the drusen-like material showed retinal pigment epithelium (RPE) elevations with moderate hyperreflectivity underneath. Multiple imaging modalities of the posterior segment can provide detailed information about the ocular involvement of MPGNII and help us to confirm the diagnosis and to follow the lesions.

Keywords: Autofluorescence; Membranoproliferative glomerulonephritis type II; Optical coherence tomography.

Figure 1

Fundus photograph of the right eye shows retinal pigment epithelial changes on macula and drusen like deposits in the peripheral retina (a). Fundus photograph of the left eye demonstrates drusen like deposits in the periphery (b).

Figure 2

Fluorescein angiography (FA) of the right eye illustrates large peripapillary hyperfluorescence due to window defect in early (a), mid (e), and late (i) phases. FA of the left eye shows window defect superotemporally to the optic disc and hyperfluorescence spots in the periphery in early (c), mid (g), and late (k) phases. Indocyanine green angiography (ICG-A) demonstrates marked peripapillary hypofluorescence and scattered hyperfluorescent spots from early to late phases in the right eye (b, f, j) and hyperfluorescent spots becoming more marked in the late phases of ICG-A in the left eye (d, h, l).

Figure 3

Hyperfluorescence spots due to drusen like deposits in the superior periphery in early to late phases of FA in the left eye (a, c, e). ICG-A demonstrates prominent hyperfluorescent spots in late phases, consistent with the deposits in the same area (b, d, f). Fundus autofluorescence shows hyperautofluorescence in the deposit areas (g).

Figure 4

OCT of the right macula demonstrates loss of IS/OS line (a). Scans from the deposits show pigment epithelial irregularity and elevations with underlying moderate hyperreflective material (b).