PMC5778553_01
Fundus photographs and autofluorescence of the patient with bilateral retinopathy related to Chikungunya fever in an elderly male. The right eye shows presence of retinal pigment epithelial changes in the nasal peripapillary regions along with resolved disc edema (a). There are similar changes at the level of the outer retinal layers and the retinal pigment epithelium near the inferior arcade. Fundus photograph of the left eye shows presence of retinal pigment epithelial changes and hypopigmented areas suggestive of chorioretinal lesions near the superior arcade and at the center of the macula (b). Autofluorescence imaging of the right eye (c) shows hypoautofluorescence in the nasal peripapillary lesions and stippled irregular hyperautofluorescence in the area temporal to the optic nerve head, inferiorly and near the inferior arcade. Similarly, autofluorescence imaging of the left eye (d) shows hypoautofluorescence with linear streaks of hyperautofluorescence in the macular lesions. The superior arcade lesions are hyperautofluorescent
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F1
The macula was spared [Fig. 1]. There was an area of hyperautofluorescence at the superior arcade near the optic nerve head [Fig. 1].
Spectral-domain optical coherence tomography imaging of the right and left eyes of the patient with Chikungunya retinopathy. Spectral-domain optical coherence tomography of the right eye (a) Passing through the macula shows normal foveal contour. There are inner retinal hyperreflective foci (white arrowhead) colocalized to the bright lesions on infrared imaging. Spectral-domain optical coherence tomography of the left eye (b) Shows thinning of the central macula with decrease in thickness of various retinal layers. The retinal pigment epithelial layer shows slight elevation with underlying hyperreflectivity and disruption of external limiting membrane, ellipsoid and myoid zone, and irregular discontinuity of the retinal pigment epithelium (white arrows). Similar changes are seen in the optical coherence tomography B-scan passing just inferior to the fovea. There are outer retinal changes and disruption of various retinal layers (c)
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F2
OCT scan through the macula of OS showed the presence of outer retinal disruption (disruption of the external limiting membrane [ELM], ellipsoid, and myoid zone) and mild RPE elevation and focal thickening [Fig. 2]. OCTA of OD showed an irregular decrease in the SCP and DCP.
Optical coherence tomography angiography of the right eye (a-c) and left eye (d-f) (en face optical coherence tomography angiography scans along with corresponding structural optical coherence tomography angiography scan). The superficial retinal slabs of the right and left eye (a and d) show irregularly decreased vascularity. The deep retinal slab of the right and left eye (b and e) show areas of decreased vascularity. The deeper retinal layers are more significantly affected compared to the superficial slabs. The choriocapillaris slab (c and f) show focal dark areas of hypo-reflectivity without corresponding signal loss on structural optical coherence tomography angiography suggestive of true choriocapillaris flow deficit
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F3
The choriocapillaris slab in OS showed discrete areas of hyporeflectivity suggestive of flow deficit, more obvious compared to OD [Fig. 3].