This 67YO male with type 2 diabetes presented with these asymptomatic blood vessels overlying the left nerve, which did not leak on fluorescein angiography. Vision was 20/20 OU. Mild non-proliferative retinopathy was noted bilaterally, and there was a mild asymptomatic macular pucker in the left eye.
We felt that these vessels represented an arteriovenous malformation (AVM). The other possibility would be extremely large and complex collateral vessels, but we saw no evidence of retinal vein occlusion, clinically or angiographically.
Learning Points:
Since about 25% of patients with AVMs can have intracranial venous anomalies, a brain MRI is usually recommended. Our patient was asymptomatic, and his MRI and MRA were normal.
