Multimodal Imaging in Lipemia Retinalis

To describe the multimodal imaging characteristics of the development and resolution of lipemia retinalis in a patient with severe hypertriglyceridemia.

Evaluation included ultra-widefield (UWF) pseudocolor and autofluorescence imaging, UWF optical coherence tomography (OCT), fluorescein angiography, indocyanine green angiography, and ultra-widefield OCT angiography.

A 43-year-old man with type 2 diabetes and a history of pancreatitis presented for routine screening. UWF pseudocolor imaging revealed diffuse creamy-white vessels most prominent beyond the posterior pole, and OCT demonstrated corresponding hyperreflectivity in the vascular lumens, while angiographic studies confirmed preserved perfusion. Laboratory tests showed a triglyceride level of 5,885 mg/dL and a cholesterol of 876 mg/dL. After initiation of appropriate lipid-lowering therapy, triglycerides decreased to 167 mg/dL and cholesterol to 148 mg/dL within one month, with apparent normalization of the vascular appearance and resolution of OCT findings.

Lipemia retinalis is a reversible manifestation of intravascular chylomicronemia. UWF imaging and OCT are particularly useful for documentation and follow-up. Prompt recognition should lead to urgent systemic therapy to reduce the risk of acute pancreatitis and cardiovascular complications.