A rare finding on the fundus or “dancing” retina: a clinical case

Aim. To attract the attention of ophthalmologists to the possibilities of optic coherence tomography (OCT) in the differential diagnosis of the retinal peripheral mass by detecting its pulsation. Materials and methods. A 47-year-old female patient has been under observation since 2021 for primary open-angle glaucoma (stage 1a, left eye) and moderate myopia in both eyes. She has been wearing glasses since childhood and receives preservative-free latanoprost for intraocular pressure control. Regular examinations every six months include tonometry, ophthalmoscopy, perimetry, and OCT / OCT angiography (OCTA) imaging for monitoring glaucoma progression and retinal health. The Cross Line mode was used for B-scans focused on vortex vein ampullae, with video recordings capturing dynamic retinal and choroidal changes. Results. The patient complained of “lightning” and a floating spot in front of the left eye, and a thorough examination of the central and peripheral retina was performed. The OCT and OCTA examinations of the central retina revealed thinning of the ganglion cell layer and peripapillary nerve fiber layer in the upper-temporal sector, a decrease in the density of blood vessels, which corresponds to the initial signs of glaucoma. The OCT-B scan of the peripheral area at the level of the ophthalmoscopic grayish radiating focus revealed a convex change in the retinal profile, a homogeneous hyporeflective cavity with clear borders in the choroid, without changes in the retinal layers and subretinal fluid. Rhythmic retinal pulsations synchronized with the heart rate were observed. The differential diagnosis included choroidal metastases, melanoma, lymphoma, hemangioma, nevus, and varicose dilation of the vortex vein ampulla, the latter diagnosis being confirmed. Conclusions. Varicose dilation of the vortex vein ampulla is a rare condition that mimics benign and malignant retinal diseases, requiring differential diagnosis, where OCT is useful for identifying morphological and dynamic changes, with recognition of retinal fluctuation as the final diagnostic criterion.