A 36-year-old woman was referred to our emergency department with blurred vision and no previous influenza episode in January 1992.
The examination showed visual acuity (VA) in the right eye (OD) 20/30 and in the left eye (LE) 20/60, anterior chamber cells of 1+ both eyes (AO) and numerous white spots (AO) with multiple white spots.
Fluorescein angiography showed multiple hyperfluorescent points.
Treatment was initiated with 40 mg methylprednisolone IM daily (soluble Urbason® 40 mg, Aventis Pharma S.A., Madrid), atropine sulfate 10 mg/ml topical Alcon dexamethasone® 12 hours (AtropinA.
After two weeks of treatment she achieved a VA of 20/20 in BE.
The systemic tests requested (basic analytical, chest X-ray, serology, angiotensin converting enzyme and Mantoux) were negative.
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Four years later, she presented a new recurrence, more pronounced in the RE, with visual loss at the level of 20/60 RE and 20/30 LE, without showing campimetry alterations.
The same systemic pattern was initiated as in the previous episode with complete visual recovery one month after treatment, persisting some white spot and superior temporal peripapillary pigment in the right eye.
A new, lighter sprout occurred in September 2001.
The visual acuity was 20/25 RE and 20/20 LE. The funduscopic examination showed white-yellowish spots distributed by posterior pole and alteration of the macular pigment epithelium in AO.
Topical and systemic corticosteroid treatment was initiated as in the first episode.
At three weeks from the beginning of the shoot, VA decreased to 20/40 OD and 20/60 OI, so it was decided to add oral metotrexate (Metotrexethato Lederle®)
A negative HLA A29 study was requested.
In April 2005, the patient remained asymptomatic, with VA in 20/30 RE and 20/25 LE.
In the eye fundus, the patient presented a nasal juxtafoveolar neuroepithelium elevation in the right eye. Optical coherence tomography confirmed the diagnosis of suspected RSNVM.
The patient refused treatment, although five months later, with an VA of 20/60 on yesterday, she was treated for RSNVM, with photodynamic therapy photodynamicsudyne®, Madrid Origon, Barcelona S.
VA in the RE improved to 20/40".
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At present, the patient has a VA 20/40 RE and OI, tenuous white-yellowish spots in the posterior pole of both eyes, and several lesions in the lower oxilloma oxilloma, AO.
