An Incidental Group 2 Retinal Arteriovenous Malformation in an Asymptomatic Young Adult

Abstract

To describe the clinical and multimodal imaging features of an incidentally detected Group 2 retinal arteriovenous malformation (AVM) in an asymptomatic young adult and highlight the importance of systemic neuroimaging in such cases. An 18-year-old male with no visual or neurological symptoms was found to have a unilateral retinal vascular anomaly during routine ophthalmic examination. Best-corrected visual acuity was 20/20 in both eyes, with normal anterior segment findings and intraocular pressure. Fundus examination of the left eye revealed markedly dilated and tortuous retinal vessels with a direct arteriovenous communication and no intervening capillary bed, consistent with a Group 2 retinal AVM. Structural optical coherence tomography demonstrated large vascular lumens within the inner retinal layers without macular edema, subretinal fluid, or exudation. Optical coherence tomography angiography demonstrated prominent flow within the abnormal vascular channels with relative preservation of the surrounding retinal architecture. Focal signal attenuation adjacent to the large vessels was noted, likely related to dense vascular shadowing. Contrast-enhanced magnetic resonance imaging of the brain and orbits did not reveal an associated intracranial or orbital vascular malformation. An isolated retinal AVM may be incidentally identified in an otherwise asymptomatic young individual with preserved retinal architecture and visual function. Multimodal retinal imaging provides complementary structural and vascular information, while neuroimaging is important to exclude associated intracranial or orbital vascular malformations, particularly those occurring as part of Wyburn–Mason syndrome. Conservative management with periodic ophthalmic surveillance is appropriate in the absence of secondary ocular complications.