Optical coherence tomography angiography in unilateral multifocal choroiditis and panuveitis: A case report

Abstract

Rationale: Optical coherence tomography angiography (OCT-A) has the advantage to visualize the microvascular structure of the retina in vivo and was utilized clinically in various neovascular retinal diseases. The OCT-A has also been used to examine the lesion in multifocal choroiditis and panuveitis (MCP). This study aimed to describe a case of MCP and present the disease process of a punched-out lesion in the chorioretina with neovascular activity using OCT-A.

Patients concerns: A 32-year-old female Caucasian patient presented with a 2-week history of progressive blurred vision in her right eye with photophobia and a diminished temporal visual field. On presentation, her best corrected visual acuity was 6/60 in the right eye with a prominent anterior uveitis seen under slit lamp examination.

Diagnoses: Dilated fundus examination of the right eye showed vitritis and multiple, punched-out yellowish-white lesions over the peripheral retina. Additional multimodal imaging (MMI) were done including fluorescein angiography (FA), indocyanine green angiography (ICGA) and fundus autofluorescence (FAF), which all revealed characteristic findings of MCP. In general, the diagnosis of unilateral MCP was made. Furthermore, one of the punched-out lesions in the right eye was particularly selected and examined under OCT and OCT-A, which revealed a subretinal elevated lesion with high flow signal under OCT-A.

Interventions: Treatment with oral prednisolone at 30 mg daily with topical prednisolone acetate 1% every 2 hours were prescribed, which were gradually tapered down within a 2-month course.

Outcomes: The patient's best corrected visual acuity of the right eye returned to 6/6 at 2 months after the diagnosis. The flow signal in the OCT-A study of the punched-out lesion had also resolved after steroid treatment.

Lessons: The MCP is an uncommon uveitis with multiple inflammatory chorioretinal lesions. Using multimodal imaging technique, physicians can better differentiate these lesions for diagnosis and for further monitoring. Our results demonstrated that these chorioretinal lesions in MCP may display neovascular activities that might not be seen easily using conventional FA or ICGA study. With OCT-A, ophthalmologists could identify and monitor subtle choroidal neovascularization (CNV) changes over these punched-out lesions.

Figure 1

A pretreatment multimodal imaging study of a 32-year-old Caucasian woman who presented with multifocal choroiditis with panuveitis (MCP) in her right eye. (A) Ultra-wide field color fundus image. (B) Fluorescein angiography (FA). (C) Indocyanine green angiography (ICGA). (D) Fundus autofluorescence (FAF) ultra-wide field image. The yellow circles indicate the singled out active lesion being studied.

Figure 2

The singled out active lesion before treatment. (A) Cross-line optical coherence tomography (OCT) showed subretinal heterogenous deposit, disruption of RPE integrity and outer retina structure, and vitreous cell overlying the lesion. (B–E) Optical coherence tomography angiography (OCT-A) at different layers, (B) superficial capillary plexus, (C) deep capillary plexus, (D) outer retinal layer, and (E) choroidal capillary layer. Yellow circles indicate the singled-out lesion with flow signal in OCT-A. RPE = retinal pigment epithelium.

Figure 3

The singled-out lesion 3 weeks after treatment. (A) Cross-line optical coherence tomography (OCT) showed recovery of the previously disrupted RPE and outer retina structure with fewer subretinal hypereflective deposits, and near absence of vitreous cell. (B–E) Optical coherence tomography angiography (OCT-A) at different layers, (B) superficial capillary plexus, (C) deep capillary plexus, (D) outer retinal layer, and (E) choroidal capillary layer. Yellow circles indicate the singled-out lesion. RPE = retinal pigment epithelium.