Case series of neuroretinitis in Korea

Abstract

Background: To present the clinical characteristics of neuroretinitis in Korea.

Methods: Twelve patients with neuroretinitis between January 2009 and September 2020 were retrospectively reviewed. Neuroretinitis was diagnosed based on fundus findings, optical coherence tomography, and fluorescein angiography. The serological findings of each patient were reviewed.

Results: Fifteen eyes of 12 patients (9 male and 3 female), with a mean age of 46.0 ± 10.7 years were included. Of the nine patients who underwent serological testing for Toxocara antibodies, six (66.6%) were positive. One patient had high titers of Toxoplasma immunoglobulins M and G. One patient diagnosed with dengue fever was suspected to have neuroretinitis in both eyes. There were no related abnormalities in the serological findings in four patients (33.3%) out of 12 patients. There were no suspected cases of cat-scratch disease. The six patients who were positive for Toxocara antibodies were older (mean age: 54.5 ± 9.1 years) than the others (mean age: 37.5 ± 4.4 years, p = 0.004). The four patients without any abnormal serological findings were relatively younger (mean age: 35.7 ± 3.0 years) than the other 8 patients (mean age: 51.1 ± 10.1 years, p = 0.008).

Conclusions: Two-thirds of neuroretinitis patients were seropositive for Toxocara in the current cohort from Koreans. Causative factors in cases of neuroretinitis may vary according to age and region.

Keywords: Neuroretinitis; Ocular toxocariasis; Optic neuritis; Toxocara; Toxocariasis.

Fig. 1

Clinical manifestation of a 58-year-old man (Case 11) with neuroretinitis. Fundus photo showed optic disc edema of the right eye during his initial visit (A), optical coherence tomography of the right eye showed subretinal fluids (B), and optic disc edema (white circle). 1 month after albendazole treatment, optic disc edema disappeared and hard exudates were clearly noticed in the fundus photo (C). In the optical coherence tomography, subretinal fluid was nearly absent and hard exudates became more distinct (D)

Fig. 2

Clinical manifestation of a 45-year-old man (Case 8) with high titers of Toxoplasma immunoglobulins G and M. Fundus photo showed multifocal edematous and opaque retina and optic disc edema in his right eye (A), and fluorescein angiography showed that inflammatory focus was around the optic disc. (B). Subretinal fluid was observed, which continued into the optic disc head in optical coherence tomography (C, D). At 4 months after anti-Toxoplasma treatment, stellate macular exudates and several tractional membranes were observed in the fundus photo (E) and in optical coherence tomography (F). At 6 years after epiretinal membrane removal, chorioretinal scarring on the macula and pale optic disc were observed (G, H). The best-corrected visual acuity was finger count

Fig. 3

Clinical manifestation of a 37-year-old woman (case 12) with dengue fever. At 7 days after empirical antibiotics therapy for the fever, fundus photography (A, B) revealed the slightly blurred margin of the optic nerve head (white boxes), which was suspected to be in the process of recovering from optic disc swelling. Optical coherence tomography showed scant subretinal fluids (C, D). At 1 month after the initial visit, fundus photos (E and F) and optical coherence tomography (G, H) showed that these abnormalities returned to normal

Fig. 4

Clinical manifestation of a 40-year-old woman without any specific laboratory findings. Fundus photographs showed optic disc edema of only the left eye (A, B), optic disc swelling was observed, although there was no macular abnormality seen in optical coherent tomography (E) at the initial visit. Fluorescein angiography (C, D) showed that the inflammatory focus was around the optic disc of the left eye. Three weeks after the initial visit, optic disc swelling was noticed in both eyes (F, G), and subretinal fluid and hard exudates were observed in optical coherent tomography of her left eye (H). Three months later, without any specific treatment, these abnormalities returned to almost-normal (I, J, K)