PMC3975193_01
Color fundus photograph obtained at the first visit (a, b) and 2 years later (c). Yellow arrowheads indicate the white dots in the nasal retina. White arrowheads indicate longitudinal narrowing of the retinal arteries. Visual fields measured using the 30-2 SITA standard program on the Humphrey Field Analyzer at baseline (d), 4 months (e), 1 year (f), 1.5 years (g), and 2 years (h). OCT images obtained at baseline (i, j), 7 months (k), and 1.5 years (l). The junction of the inner and outer segments (IS/OS) is difficult to discern in nasal retina (i), but normal surrounding the fovea (j). Blue and red arrowheads indicate a thinning of the outer retina and a shortening of the IS/OS, respectively.
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F1
Numerous white dots were seen in the nasal retina of the left eye (fig. 1a). Static perimetry showed sensitivity loss in the temporal inferior visual field of the left eye (fig. 1d). OCT showed the disappearance of the inner-segment/outer-segment (IS/OS) line at the nasal retina (fig. 1i) and the intact fovea (fig. 1j). Four months later, perimetry revealed further expansion of this loss of sensitivity in the superior nasal as well as inferior temporal fields (fig. 1e). Arterial narrowing was observed (fig. 1c), but no white dot or bone spicule pigmentation was visible. OCT revealed a parafoveal photoreceptor loss (fig. 1k). The perimetry results supported the diagnosis of a scotoma enlargement (fig. 1g). Six months after the initiation of this course of treatment, the perimetry results showed no further regression of the patient's visual field (fig. 1h).
Wide-field autofluorescence images at the first visit (a), 4 months (b), 7 months (c), and 1.5 years (d). Areas of hyper-autofluorescence were scattered mainly in the nasal retina at baseline (a) and gradually encroached upon the posterior pole (b-d). FA at 7 months (e), 1.5 years (f), 1 week after steroid pulse therapy (g), and after 2 years (h). Fluorescein leakage from the vasculature has resolved almost completely after therapy (g).
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F2
Areas of hyper-autofluorescence were observed at the posterior pole in the left eye (fig. 2c). FA revealed leakage from the mid-peripheral vasculature (fig. 2e). The areas of hyper-autofluorescence at the posterior pole showed further concentric restrictions (fig. 2d). FA was performed again and revealed a marked increase in vascular leakage (fig. 2f). The results of FA performed 1 week after therapy showed a drastic reduction in leakage from the vasculature (fig. 2g). However, FA revealed recurrent leakage (fig. 2h).