PMC3141865_01
Color fundus photograph (A) right eye: normal appearance of the fundus; (B) left eye: showing edema of optic disc with some retinal infiltrates and exudates encircling the fovea in a shape similar to a star.
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RE fundus examination was normal (Figure 1A) and the LE revealed significant edema of the optic disc with retinal infiltrates at the posterior pole and a characteristic macular star from yellow exudates (Figure 1B).
Infrared montage of the left eye showing the optic disc surrounded by small exudates and choroidal lesions in the posterior pole midperiphery.
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IR imaging (Heidelberg HRA, wavelength 830 nm) showed some optic disc edema surrounded by subretinal fluid, and diffuse, patchy, choroidal infiltrates involving the posterior pole midperiphery ( Figure 2) otherwise invisible on ophthalmoscopy.
(A and B) Left eye: early (20  magnification) and late-phase of fluorescein angiograms showing leakage of optic disc, stellate maculopathy, and the retinal lesions revealing early blockage and late staining; (C and D) early (20  magnification) and late-phase of indocyanine green angiograms confirming a macular star and revealing early and late blockage in the same lesions observed on FA; (E and F) red-free and optical coherence tomography scan showing a focal increased reflectance at the retinal pigmented epithelium-choriocapillaris complex corresponding to the lesions (red circle).
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Fluorescein angiography (FA) conf irmed the optic disc swelling and some hypofluorescence from intraretinal infiltrates was detected (Figure 3A and B). Optic disc swelling and some masked hypofluorescence from the exudates as well as retinal infiltrates were recorded (Figure 3C and D) on indocyanine green angiography (ICG). On early ICG, just some choroidal infiltrates were seen as an area of choriocapillaris hypoperfusion (Figure 3C). Optical coherence tomography (OCT) guided by IR imaging was able to confirm different focal loci of subretinal hyper-reflectivity corresponding to the choroidal infiltrates (Figure 3E and F).
(A) Infrared montage of left eye showing residual choroidal lesions in the posterior pole after 3 years of follow-ups (black line corresponds to the optical coherence tomography [OCT] cut and red circles highlight the choroidal infiltrates circled on OCT scan); (B) OCT scans revealing a focal increased reflectivity at the level of sub-retinal pigmented epithelium-choriocapillaris complex (red circle) confirming the presence of the lesions indicated on infrared montage (see Figure 4(A)).
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The choroidal infiltrates observed by IR, also confirmed by OCT, were still found at the 2- and 3-year follow-up (Figure 4).