PMC6875519_01
Fundus photographs and optical coherence tomography at the initial visit. Fundus photographs of the right (A) and the left eye (B) show SRD with a 1.5 disc diameter. Vertical and horizontal SS-OCT images with a 12 mm diameter show SRD at the macula and elongation of the photoreceptor outer segments at the macula in the right (A) and left (B) eyes.
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Fundus examination revealed serous retinal detachment (SRD) and several retinal pigment epithelial detachments in both eyes (Figure 1).
Fluorescence and indocyanine green angiography at the initial visit. Fluorescence angiography images of the right (A and E) and the left eye (B and F) did not detect any abnormal hyperfluorescence in the macular, vessel and optic discs during both the early (A and B) and late (E and F) phases. Indocyanine green angiography images of the right (C and G) and the left (D and H) eye did not reveal any choroidal hyperpermeability or delayed perfusion during both the early (C and D) and late (G and H) phases.
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Indocyanine green angiography (Spectralis HRA+OCT; Heidelberg Engineering GmbH) showed neither leakage during both the early and late phases nor any abnormal choroidal hyperpermeability (Figure 2).
High magnification SS-OCT images at the parafoveal area of the right (A) and left (B) eyes at the initial visit. In both the area where the SRD appeared and in the adjacent area, SS-OCT detected a high reflection of the photoreceptor outer segment while the interdigitation zone was indistinguishable (between the arrowheads). SS-OCT also detected thickening (maximum diameter 75 mum) of the photoreceptor outer segment. The reflection of the retinal pigment epithelium line appeared to be brighter with slightly poorer margins.
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SS-OCT also detected thickening (maximum diameter 75 mum) of the photoreceptor outer segment (Figure 3).
Autofluorescence at the initial visit. The right and left eye exhibited no abnormal hyperfluorescence in the macular area.
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Fundus autofluorescence (FAF) showed there were no abnormalities (Figure 4).
Time course of the fundus photographs and the SS-OCT images during the patient's course of follow-up examinations. Fundus photographs and SS-OCT images at 1, 2, 3 and 4 months post-ipilimumab treatment. At 1 month, best corrected visual acuity was 16/20 in both eyes. SS-OCT revealed a slight increase in the height of the SRD at the central macula, compared to that found for the initial visit. The heights were 275 mum in the right (A) and 309 mum in the left (B) eye. At 2 months, the heights of the SRD in the right (C) and left (D) eyes were 323 mum and 345 mum, respectively. At 3 months, the heights were 323 mum in the right (E) and 345 mum in the left (F) eye. At 4 months, the heights were 158 mum in the right (G) and 232 mum in the left (H) eye. There were no changes noted in the patient's visual acuity during the course of follow-up examinations, with Snellen chart best corrected visual acuity of 16/20. Although the height of the SRD was reduced at 4 months, the SRD was still slightly observed. The high reflection of the photoreceptor outer segment also remained at 4 months.
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Although best corrected visual acuity was 16/20 in both eyes, the SRD and obscurity of the interdigitation zone remained (Figure 5).