Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2022; 10(19): 6736-6743
Published online Jul 6, 2022. doi: 10.12998/wjcc.v10.i19.6736
Multimodal imaging study of lipemia retinalis with diabetic retinopathy: A case report
Sheng-Juan Zhang, Zhong-Yang Yan, Li-Fei Yuan, Yan-Hui Wang, Li-Fei Wang
Sheng-Juan Zhang, Zhong-Yang Yan, Li-Fei Yuan, Yan-Hui Wang, Li-Fei Wang, Department of Ophthalmology, Hebei Provincial Eye Hospital, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Eye Institute, Xingtai 054001, Hebei Province, China
Author contributions: Yan ZY and Wang YH were the ophthalmologists, responsible for the clinical treatment of the patient; Zhang SJ and Yuan LF analyzed and interpreted the imaging findings, reviewed the literature, and contributed to drafting the manuscript; Wang LF was responsible for revising the manuscript for important intellectual content; and All authors gave their approval for the submission of the final version of the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Fei Wang, MD, PhD, Chief Doctor, Professor, Department of Ophthalmology, Hebei Provincial Eye Hospital, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Eye Institute, No. 399 East Quanbei Street, Xingtai 054001, Hebei Province, China. wlfhb@126.com
Received: February 15, 2022
Peer-review started: February 15, 2022
First decision: March 25, 2022
Revised: March 27, 2022
Accepted: April 22, 2022
Article in press: April 22, 2022
Published online: July 6, 2022
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: Lipemia retinalis, Fundus color photography, Infrared photography, Optical coherence tomography, Fundus fluorescein angiography, Case report

Core Tip: Lipemia retinalis (LR) is rarely seen in clinics. It occurs in individuals with extreme hypertriglyceridemia, usually when triglyceride levels reach 2000–2500 mg/dL. However, it is often not recognized by ophthalmologists. Previous examinations have focused on changes in color shown in fundus photography of LR. In this patient, retinal abnormalities were detected by fundus imaging, which were further confirmed by blood tests. We report the characteristics of LR multimodal imaging, which deepened our understanding of the imaging characteristics of LR.