PMC8514923_01
Spectral domain OCT (SD-OCT) at the first presentation. (a) Right eye: multiple tiny Drusen-like RPE elevations. (b, c) Left eye: retinal edema, increased central macular thickness (CMT), multiple RPE irregularity simulating Drusen, and inner retinal hyperreflective lesion indicating retinitis at the superotemporal of the optic disc.
CRIOPM2021-9496173.001.jpg
PMC8514923_01_CRIOPM2021-9496173.001.jpg
fig1
The right eye appeared normal except for senile cataract and small Drusen-like lesions (Figure 1).
Color fundus photograph, one month after starting the antiviral therapy. (a) Right eye: multiple subretinal punctate lesions resembling Drusen scattered on the temporal side of the fovea. (b) Left eye: vitreous haziness, disc paleness, and resolving retinitis associated with pigmentary change at the macular area and superior to the disc.
CRIOPM2021-9496173.002.jpg
PMC8514923_01_CRIOPM2021-9496173.002.jpg
fig2
Vitreous reaction accompanied by retinal vasculitis and punctate Drusen-like subretinal infiltration foci were observed in the examination of the right eye (Figure 2).
Fundus autofluorescence (FAF), one month after starting the antiviral therapy. (a) Right eye: numerous hyperautofluorescent dots scattered on the posterior pole without vitreous opacity. (b) Left eye: stippled mixed hyper-hypoautofluorescent dots (leopard pattern) at the posterior pole and hypoautofluorescent vitreous opacity corresponding to the vitritis.
CRIOPM2021-9496173.003.jpg
PMC8514923_01_CRIOPM2021-9496173.003.jpg
fig3
FAF showed numerous hyperautofluorescent dots scattered at the posterior pole of the right eye and stippled mixed hyper- and hypoautofluorescent dots (leopard pattern) at the posterior pole and vitreous opacity corresponding to the vitritis in the left eye (Figure 3). Fluorescein angiography was not provided due to an allergic reaction.
One month after starting the antiviral therapy, SD-OCT of the right eye (a) and the left eye (b) shows the exacerbation of the subretinal infiltration during the one-week follow-up period (the top and the middle rows). Two weeks after intravitreal injection of methotrexate and rituximab, significant improvement was observed in macular OCT (bottom row).
CRIOPM2021-9496173.004.jpg
PMC8514923_01_CRIOPM2021-9496173.004.jpg
fig4
Clinical response was good (Figure 4), and BCVA increased to 20/32 and 20/50 in the right and left eyes, respectively.