Multimodal imaging study of lipemia retinalis with diabetic retinopathy: A case report

Abstract

Background: Lipemia retinalis (LR) is a rare disease related to hypertriglyceridemia. However, the symptoms of hypertriglyceridemia are insidious and difficult to detect without blood tests. The fundus is the only site where blood vessels can be observed directly. Understanding the specific performance of LR in multimodal imaging fundus examinations can help diagnose more patients with abnormal hyperlipidemia.

Case summary: A 29-year-old woman with type 2 diabetes presented to our clinic complaining of a six-day loss of visual acuity in the left eye. The fundus color images showed typical LR: Arteries and veins were the same pink-white color. Infrared images showed hyperinfrared reflections of the arteries and veins. Optical coherence tomography (OCT) showed numerous high point-like reflections in the retinal section, corresponding to different calibers of blood vessel sections. Medium reflections were seen in the big vessels of the choroid. Fundus fluorescein angiography (FFA) and optical coherence tomography angiography (OCTA) showed no significant changes. Laboratory examination found a total cholesterol level of 13.98 mmol/L, triglyceride 20.55 mmol/L, which confirmed the diagnosis of LR. After treatment to lower blood lipids and control blood glucose, the fundus imaging showed that the blood lipids in the patient had returned to normal.

Conclusion: LR shows specific changes in fundus color photography, infrared photography, and OCT. FFA and OCTA were not sensitive to LR changes.

Keywords: Case report; Fundus color photography; Fundus fluorescein angiography; Infrared photography; Lipemia retinalis; Optical coherence tomography.

Figure 1

Fundus images with lipemia retinalis and the fundus in the same case with normal blood lipids. A, B: The right and left eye fundus images with lipemia retinalis, respectively, and showed a pink–white color of the fundus, arteries, and veins. It had simultaneous vitreous hemorrhage (B); C, D: The right and left eye fundus images in the same case with normal blood lipids.

Figure 2

Infrared images with lipemia retinalis and infrared images of the same case with normal blood lipids. A, B: Infrared images of lipemia retinalis showed hyperinfrared reflection of retinal vessels; C, D: Infrared images of the same case with normal blood lipids showed hypoinfrared reflection of retinal vessels.

Figure 3

Optical coherence tomography with lipemia retinalis and optical coherence tomography of the same case with normal blood lipids. A: The right eye Optical coherence tomography (OCT) with lipemia retinalis, which showed point-like high reflections in the retina, corresponding to the cross-section of retinal blood vessels, and medium reflections in the choroid big vessels; B: The right eye OCT of the same case with normal blood lipids.

Figure 4

Fundus fluorescein angiography with lipemia retinalis, fundus fluorescein angiography of the present case with normal blood lipids, and optical coherence tomography angiography of this case with lipemia retinalis. A-C: The fundus fluorescein angiography of this case with normal blood lipids; D, E, and F: The fundus fluorescein angiography of this case with lipemia retinalis (LR); A–F showed no significant difference in retinal filling time and fundus fluorescence between the patient’s hypertriglyceridemia condition and a normal blood lipid condition; G-J: The optical coherence tomography angiography of LR, showing a nonperfusion area consistent with fundus fluorescein angiography.