PMC7346631_01
a Color fundus at the time of diagnosis. Vitritis and an active toxoplasmic lesion are visible in the papillomacular bundle. b Optical coherence tomography (OCT) B-scan with the total retina slabs. c OCT B-scan over the active lesion shows retinal hyperreflectivity (arrow) and a thickened choroid (asterisk) under the lesion. d A 9 x 9-mm field of view swept-source OCTA (SS-OCTA) image shows inferiorly located no OCTA decorrelation signal, suggestive of reduced blood flow. e Structural en face image. f Color fundus image 13 weeks after those in (a-e): inflammatory signs are absent, but an atrophic scar is visible. g OCT B-scan with the total retina slabs. h Retinal layers are unrecognizable at the lesion site (arrow) and choroidal thinning is seen (asterisk). i A 9 x 9-mm field of view on SS-OCTA shows increase in flow signal after treatment. The arrows indicate the vascular loops. j A structural en face image
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Fig1
A fundus examination showed 2+ vitritis and a focal necrotizing retinal choroidal lesion with a retinal hemorrhage in the papillomacular bundle (Fig. 1a). A SS-OCT image obtained through the active lesion showed nerve fiber swelling and choroidal thickening (Fig. 1b, c). The OCTA performed on the lesion showed no decorrelation signal (Fig. 1d), suggestive of reduced blood flow. The patient was treated with an oral combination of 160 mg of trimethoprim and 800 mg of sulfamethoxazole, 1 tablet bid for 6 weeks, and 40 mg/day of prednisone tapered over 6 weeks which resulted in lesion regression (Fig. 1f) and VA improvement (20/125). The borders of the retinal layers in the retinal choroidal lesion were unrecognizable (Fig. 1g, h). The choroid surrounding the lesion site was thinner compared to the adjacent areas (Fig. 1h). An OCTA image of the lesion showed increase in flow signal and anomalous vessels in the retinochoroiditis area (Fig. 1i).
PMC7346631_02
a Color fundus at the time of diagnosis. An active toxoplasmic lesion is visible adjacent to the retinal choroidal pigmented scars. b An optical coherence tomography (OCT) B-scan with slabs extending from the vitreous to the inner nuclear layer. Thickened choroidal tissue is seen adjacent to the lesion site (asterisk). c An OCT B-scan with overlying color-coded flow in which red represents the retinal capillaries and pre-retinal neovascularization, and pink represents the choroid. d A 6 x 6-mm field of view on OCT angiography (OCTA) shows a neovascular seafan-like complex (arrow) and areas of no decorrelation signal. e A structural en face OCT shows a hyporeflective lesion suggestive of retinal neovascularization. f A color fundus image obtained 5 weeks after those in (a-e) shows that the area of retinitis has regressed following ocular toxoplasmosis treatment. g An OCT B-scan with slabs extending from the vitreous to the inner nuclear layer. h An OCT B-scan with overlying color-coded flow shows that the retinal neovascularization appears unchanged after the systemic anti-Toxoplasma treatment. i A 6 x 6-mm OCTA image shows unchanged retinal neovascularization (arrow). j A structural en face OCT image
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Fig2
SS-OCT and SS-OCTA images were obtained 4 weeks after the treatment end (Fig. 2f-j).
PMC7346631_03
a Color fundus at the time of diagnosis. An active toxoplasmic lesion is visible adjacent to the retinal choroidal pigmented scars. b An optical coherence tomography (OCT) B-scan with slabs extending from the vitreous to the inner nuclear layer. Thickened choroidal tissue is seen adjacent to the lesion site (asterisk). c An OCT B-scan with overlying color-coded flow in which red represents the retinal capillaries and pre-retinal neovascularization, and pink represents the choroid. d A 6 x 6-mm field of view on OCT angiography (OCTA) shows a neovascular seafan-like complex (arrow) and areas of no decorrelation signal. e A structural en face OCT shows a hyporeflective lesion suggestive of retinal neovascularization. f A color fundus image obtained 5 weeks after those in (a-e) shows that the area of retinitis has regressed following ocular toxoplasmosis treatment. g An OCT B-scan with slabs extending from the vitreous to the inner nuclear layer. h An OCT B-scan with overlying color-coded flow shows that the retinal neovascularization appears unchanged after the systemic anti-Toxoplasma treatment. i A 6 x 6-mm OCTA image shows unchanged retinal neovascularization (arrow). j A structural en face OCT image
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Fig2
SS-OCT and SS-OCTA images were obtained 4 weeks after the treatment end (Fig. 2f-j).
a Color fundus 6 weeks after treatment. The pink and blue arrows indicate the B-scan positions in B and C. b An optical coherence tomography (OCT) B-scan with the outer retina slabs. Hyperreflective material is seen in the subretinal space (asterisk). c An OCT B-scan with overlying color-coded flow in which red represents the retinal capillaries, and pink represents the choroid and the choroidal neovascular membrane (CNVM). d A 3 x 3-mm field of view on a swept-source OCT angiography (SS-OCTA) image suggests the presence of a CNVM. e A structural en face OCT shows hyporeflective dots in the CNVM location. f Color fundus image 4 weeks after those in (a-e). g An OCT B-scan with the outer retina slabs. h An OCT B-scan with overlying color-coded flow. i A 3 x 3-mm OCTA image showing the CNVM. j A structural en face image
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Fig3
The patient was treated with an oral combination of 160 mg of trimethoprim and 800 mg of sulfamethoxazole, 1 tablet bid for 6 weeks, and 60 mg daily of prednisone that was tapered over the ensuing weeks, which resulted in lesion regression (Fig. 3a) and resolution of the visual symptoms. SS-OCT performed 6 weeks after treatment through the retinal choroidal scar showed a subretinal area of hyperreflectivity extending toward the choroid (Fig. 3b, c), which was highly suggestive of a subclinical CNVM on SS-OCTA (Fig. 3d).