PMC6528075_01
Fundus photographs of case 1. a Multiple atrophic retinal lesions with ultrawide-field color fundus photograph. b Fundus autofluorescence images. c Late-phase hyperfluorescence of the lesions with fluorescein angiography. d Subretinal fluid in the subfoveal region, hyperreflective materials in ellipsoid zone, and hyperplasia of retinal pigment epithelium (RPE) and ellipsoid zone presented with optical coherence tomography (OCT) image at the administration. e OCT images 1 year after introduction of adalimumab demonstrated alleviation of RPE hyperplasia.
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F1
We detected bilateral conjunctival hyperemia, mild iridocyclitis in the right eye, and multiple atrophic retinal lesions with some exudative changes widespread from the posterior pole to peripheral retina in both eyes (Fig. 1a). Fundus autofluorescence presented hypoautofluorescent regions corresponding to the outer retinal atrophy (Fig. 1b), and fluorescein angiography (FA) demonstrated late staining in the foveal region, especially from the margins of the region and vascular leakage in peripheral region (Fig. 1c). Hyperplasia of retinal pigment epithelium (RPE) and ellipsoid zone were also observed (Fig. 1d). OCT image demonstrated alleviation of RPE hyperplasia, turned into rarefaction of outer retina and ellipsoid zone (Fig. 1e).
PMC6528075_02
Fundus photographs of case 2. a Ultrawide-field color fundus photograph shows widespread multiple chorioretinal atrophic lesions. b Central hypoautofluorescence demonstrated with fundus autofluorescence image. c Late-phase hyperfluorescence of the lesions with fluorescein angiography. d Late-phase hyperfluorescence in the area coincides with the clinical lesions with indocyanine green angiography.
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F2
A 22-year-old man was examined at a local clinic for visual deterioration in both eyes, and widespread multiple chorioretinal lesions were found in both fundi (Fig. 2a). Fundus autofluorescence demonstrated increase in central hypoautofluorescence within the lesions corresponding to the outer retinal atrophy and RPE hyperplasia (Fig. 2b). FA demonstrated hyperfluorescence of the lesions in late phase (Fig. 2c), and indocyanine green angiography showed hypofluorescence in the area coincide with the clinical legions (Fig. 2d).
Subfoveal optical coherence tomography images of case 2. a Small amount of subretinal hyperreflective materials, focal outer retinal disruption, and subfoveal retinal pigment epithelium (RPE) hyperplasia were observed at the administration. b The recession of RPE hyperplasia occurred 9 months after the introduction of adalimumab.
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F3
Change in OCT findings are shown in Figure 3. Small amount of subretinal hyperreflective materials, focal outer retinal disruption, and subfoveal RPE hyperplasia were observed at the first visit (Fig. 3a). Ellipsoid zone was rarefied at the site of prior hyperplasia (Fig. 3b).