PMC3884189_01
Changes of BCVA throughout the disease course. Day -3 was the day the patient first visited our hospital, and it indicates the third day before the initiation of systemic steroid therapy. Day 0 indicates the first day of systemic steroid therapy. Day 11 indicates the 11th day after initiation of systemic steroid therapy. BCVA OD and BCVA OS indicate BCVA of the right and left eye, respectively.
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F1
Best-corrected visual acuity (BCVA) measured using the Landolt ring chart was 0.03 and 1.5 in the right and left eye, respectively (fig. 1, day -3; 3 days prior to steroid pulse therapy). The next day, he presented with rapid loss of vision in his left eye, and BCVA in his left eye had decreased from 1.5 to 0.1 (fig. 1, day -2). Fifteen days after initiation of therapy, BCVA was 0.09 in both eyes (fig. 1). Until day 33 of therapy, BCVA was <0.1 in both eyes, and it changed to 0.1 in both eyes on day 34 after therapy initiation (fig. 1). Eventually, vision began to recover and BCVA improved to 0.4 in the right eye and 0.5 in the left eye (fig. 1, day 48). On day 111 of therapy initiation, BCVA improved to 0.7 in the right eye and 0.6 in the left eye (fig. 1), and OCT revealed clear reorganization of the IS/OS line (fig. 4e, f). One year after therapy initiation, BCVA remained 0.7 in the right eye and 1.0 in the left eye.
Fundus photographs taken on day -1. Day -1 indicates the day before the initiation of systemic steroid therapy. a, b Fundoscopy revealing yellow-white lesions in the posterior pole of both eyes. The lesions are mainly located in the macular area bilaterally. c, d Apparent hypofluorescence is unremarkable in the early phase of FA.
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F2
Best-corrected visual acuity (BCVA) measured using the Landolt ring chart was 0.03 and 1.5 in the right and left eye, respectively (fig. 1, day -3; 3 days prior to steroid pulse therapy). The next day, he presented with rapid loss of vision in his left eye, and BCVA in his left eye had decreased from 1.5 to 0.1 (fig. 1, day -2). Fundoscopy revealed a yellow-white lesion in the posterior pole of his left eye, which was similar to the lesion in his right eye (fig. 2a, b). FA (fig. 2c, d). Fluorescein dye in both eyes became gradually enhanced in the late phase of FA (not shown).
a, b SD-OCT images on day -1. Day -1 indicates the day before the initiation of systemic steroid therapy. SD-OCT images of both eyes showing serous retinal detachment with a subretinal septum and an intraretinal compartmentalized cystic space. The compartmentalized intraretinal space was observed to contain two hyperreflective membranous layers (white arrow). In the left eye, PED was observed (red arrow). c, d On day 1, SD-OCT revealed that the subretinal fluid began to decrease. Disruption of the hyperreflective membranous layers in the intraretinal spaces (orange arrow) was observed. Day 1 indicates the first day after initiation of systemic steroid therapy. e, f On day 3, the amount of subretinal fluid almost disappeared, but the IS/OS line remained disorganized in the affected area. Day 3 indicates the third day after initiation of systemic steroid therapy.
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F3
Best-corrected visual acuity (BCVA) measured using the Landolt ring chart was 0.03 and 1.5 in the right and left eye, respectively (fig. 1, day -3; 3 days prior to steroid pulse therapy). SD-OCT images of both eyes showed serous retinal detachment with a subretinal septum and an intraretinal compartmentalized cystic space (fig. 3a, b). In his left eye, pigment epithelial detachment (PED) was observed on OCT (fig. 3b). After initiation of systemic steroid therapy, SD-OCT revealed that the amount of subretinal fluid decreased immediately, but the inner segment/outer segment (IS/OS) line remained disorganized (fig. 3c-f).
a, b On day 15, OCT images showed that the IS/OS line remained disorganized, the retina appeared to be thin, and the outer nuclear layer appeared to be poorly reorganized. Day 15 indicates the 15th day after initiation of systemic steroid therapy. c, d OCT detected partial recovery of the IS/OS line in the macular area of both eyes on day 48 (white arrow). Day 48 indicates the 48th day after the initiation of systemic steroid therapy. e, f Reorganization of the IS/OS line was observed by OCT on day 111 (black arrow). Day 111 indicates the 111st day after initiation of systemic steroid therapy.
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F4
In addition, OCT showed that the IS/OS line remained disorganized, the retina appeared to be thin, and the outer nuclear layer seemed to be poorly organized (fig. 4a, b). OCT revealed the partial recovery of the IS/OS line in the macular area of both eyes (fig. 4c, d).