PMC7154259_01
Fundus photographs obtained at the initial examination (a right eye, b left eye). The fundus examination findings showed no particular abnormalities in the right eye, but a large white protruding lesion of 10 PD (lateral diameter) x8 PD (longitudinal diameter) in the macular region, and slightly temporal to it, in the left eye. PD, papilla diameter.
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F1
Fundus examination showed no particular abnormalities in the right eye (Fig. 1a), but a large white protruding lesion of 10 papilla diameter (PD) (lateral diameter) x8 PD (longitudinal diameter) in the macular region, and slightly temporal to it, in the left eye (Fig. 1b).
B-scan ultrasonography image of the patient's left eye obtained at the initial examination. The B-scan ultrasonography image revealed that the lesion in the left eye appeared to have high internal reflectivity.
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F2
B-scan ultrasonography (UD-8000; Tomey  Corp., Nagoya, Japan) was performed and revealed that the lesion in the left eye appeared to have high internal reflectivity (Fig. 2).
Fundus photograph (a) and OCT image (b) of the patient's left eye. A protruding lesion was observed with a homogenous shadow on the choroid and under the retina, which was complicated by surrounding exudative retinal detachment. OCT, optical coherence tomography.
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F3
In the left eye, a protruding lesion was observed with a homogenous shadow on the choroid and under the retina, which was complicated by exudative retinal detachment around it (Fig. 3a, b).
Fluorescein angiography images (a right eye, b-e left eye). The fluorescein angiography findings showed slight fluorescein leakage in the peripheral region of the right eye (a). In the left eye, punctate fluorescein leakage corresponding to the tumor-like mass was noted at the early phase (b, c), and tissue staining and fluorescein pooling were observed from the middle to late phase (d, e).
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F4
IA; Topcon Corp., Tokyo, Japan) showed slight fluorescein leakage in the peripheral region of the right eye (Fig. 4a). In the left eye, punctate fluorescein leakage corresponding to the tumor-like mass was noted at the early phase (Fig. 4b, c), and tissue staining and fluorescein pooling were observed from the middle to late phase (Fig. 4d, e). Indocyanine green angiography (TRC-50DX Type IA) revealed low fluorescence and filling delay in the area corresponding to the tumor mass (Fig. 5a, b).
Indocyanine green angiography image of the patient's left eye. Indocyanine green angiography revealed low fluorescence (a) and filling delay (b) in the area corresponding to the tumor mass.
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F5
In the left eye, punctate fluorescein leakage corresponding to the tumor-like mass was noted at the early phase (Fig. 4b, c), and tissue staining and fluorescein pooling were observed from the middle to late phase (Fig. 4d, e). Indocyanine green angiography (TRC-50DX Type IA) revealed low fluorescence and filling delay in the area corresponding to the tumor mass (Fig. 5a, b). After the initiation of steroid therapy, the choroidal granuloma gradually decreased in size, and the patient's VA gradually improved at 3 weeks and beyond after the start of treatment (Fig. 5a, b).
Fundus photograph (a) and OCT image (b) of the patient's left eye 2 months after the start of steroid pulse therapy showing that the choroidal granuloma had markedly decreased. In addition, the patient's corrected VA was found to have improved to 0.7. OCT, optical coherence tomography; VA, visual acuity.
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F6
At 2 months after the start of treatment, the choroidal granuloma was markedly decreased, the exudative retinal detachment had disappeared, and the patient's corrected VA had improved to 0.7 (Fig. 6a, b).