PMC6358364_01
A pretreatment multimodal imaging study of a 32-year-old Caucasian woman who presented with multifocal choroiditis with panuveitis (MCP) in her right eye. (A) Ultra-wide field color fundus image. (B) Fluorescein angiography (FA). (C) Indocyanine green angiography (ICGA). (D) Fundus autofluorescence (FAF) ultra-wide field image. The yellow circles indicate the singled out active lesion being studied.
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F1
Indirect ophthalmoscopy revealed multiple white-dot lesions in the mid-periphery retina, especially focused in the nasal quadrant with some scattered pigmented lesion (Fig. 1A). Fluorescein angiography (FA) revealed an early blockage with late staining in the area of the white and pigmented dot lesions shown in the fundus examination (Fig. 1B). The ICGA showed numerous hypocyanescent lesions larger in area and number compared to the fundus examination and FA (Fig. 1C). The FAF image, captured using ultra-widefield retinal imaging, showed speckled hyper-autofluorescent pattern in the macula area, and a clustered, hypo-autofluorescent lesion at the mid-periphery retina with hyper-autofluorescence surrounding few of these clustered lesions (Fig. 1D).
The singled out active lesion before treatment. (A) Cross-line optical coherence tomography (OCT) showed subretinal heterogenous deposit, disruption of RPE integrity and outer retina structure, and vitreous cell overlying the lesion. (B-E) Optical coherence tomography angiography (OCT-A) at different layers, (B) superficial capillary plexus, (C) deep capillary plexus, (D) outer retinal layer, and (E) choroidal capillary layer. Yellow circles indicate the singled-out lesion with flow signal in OCT-A. RPE = retinal pigment epithelium.
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F2
The OCT image, acquired at presentation of the singled-out white dot lesion, revealed vitreous cell aggregation above the lesion and disruption of the inner segment/outer segment (IS/OS) junction and retinal pigment epithelium (RPE) band with subretinal hyperreflectivity deposits (Fig. 2A). The OCT-A image showed a focal area of clustered circular flow in the outer retinal level, suggesting a possible CNV formation, (Fig. 2C) and a corresponding projection shadowing at the choriocapillary layer (Fig. 2D). The focal area of suspicious neovascular flow previously seen on OCT-A (Fig. 2C) were not able to identify after treatment at week 3 (Fig. 3C and D).
The singled-out lesion 3 weeks after treatment. (A) Cross-line optical coherence tomography (OCT) showed recovery of the previously disrupted RPE and outer retina structure with fewer subretinal hypereflective deposits, and near absence of vitreous cell. (B-E) Optical coherence tomography angiography (OCT-A) at different layers, (B) superficial capillary plexus, (C) deep capillary plexus, (D) outer retinal layer, and (E) choroidal capillary layer. Yellow circles indicate the singled-out lesion. RPE = retinal pigment epithelium.
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F3
The OCT showed a recovery of the retinal structure and reduced thickness, with resolved disrupted IS/OS and RPE band with fewer subretinal deposits compared to the previous examination (Fig. 3A).