PMC6652076_01
Color fundus photographs with the 200Tx ultra-wide-field retinal imaging system (Optos) at the initial examination demonstrating multiple placoid subretinal lesions scattered from the posterior pole to the peripheral retina bilaterally. Foveal subretinal fluids are present in both eyes. (a) The right eye. (b) The left eye.
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Funduscopic examination showed bilateral macular serous retinal detachment, and the one-fourth to one-second disc diameter, placoid, multiple round, and yellow-white lesions at the level of RPE from posterior pole to far peripheral retina (Figure 1).
Horizontal enhanced depth optical coherence tomographic (EDI-OCT) images at the initial examination showing marked choroidal thickening and subfoveal detachment with subretinal septa in both eyes. (a) The right eye. (b) The left eye. The choroidal thickness at the subfovea was 578 mum in the right eye and 642 mum in the left eye.
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Spectral domain OCT (SD-OCT) showed marked choroidal thickening and macular serous retinal detachment partly with subretinal septa in both eyes, which are known as characteristic OCT findings in VKH disease (Figure 2).
Fluorescein angiography of the right eye at presentation. (a) Early-phase fluorescein angiogram shows areas of hypofluorescence corresponding to the placoid lesions. (b) Late-phase fluorescein angiogram shows the conversion of hypofluorescence to hyperfluorescence (arrows).
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FA images and subsequent progressive hyperfluorescence on late-phase FA images (Figure 3). Fundus autofluorescence (FAF) revealed the lesions were observed as increased fluorescence corresponding to the placoid lesions.
Indocyanine green angiography (ICGA) of the right eye. (a) At presentation showing loss of choroidal circulation with lesions remaining hypofluorescent in the early and late phases and even into the very late phase. (b) At 4 months after the initial examination. ICGA shows an almost complete resolution of the choroidal hypofluorescence.
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Indocyanine green angiography (ICGA) revealed that the lesions were hypocyanescent in the early and late phases of the ICGA (Figure 4(a)). Four months after the initial presentation, Patchy pigmentary lesions resolved clinically partly with chorioretinal scars and hypofluorescence lesions on ICGA images showed improvement in clinical findings (Figure 4(b)).
Horizontal EDI-OCT images of the right (a) and left (b) eyes at 2 months after the initial presentation. Subretinal fluid disappeared completely and choroidal thickness recovered within normal range in both eyes. The external limiting membrane and ellipsoid zone (inner/outer segment junction) and retinal pigment epithelium are clearly recognized bilaterally, but there are unclear parts in the interdigitation zone (arrow). The choroidal thickness at the subfovea was 300 mum in the right eye and 275 mum in the left eye.
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At 2 months' follow-up, OCT showed complete resolution of subretinal fluid and decrease of choroidal thickness in both eyes (Figure 5).