case_images: PMC10903715_01
case_images: (a) A color fundus photograph of the left eye showing a large optic nerve head (ONH) granuloma with splinter hemorrhages and few multifocal choroidal lesions. (b) Corresponding spectral-domain optical coherence tomography of the macular area with some peripapillary fluid and central macular thickening at presentation. (c) Fundus fluorescein angiography (FFA) showing leakage of the ONH with few hypofluorescent spots corresponding to the multifocal choroidal lesions seen clinically. (d) Mid-phase indocyanine green (ICG) showing multiple hypofluorescent geographic lesions more than what is clinically evident. (e) Late-phase ICG showing hypofluorescent dark patch corresponding to the exudative retinal detachment. Note the ONH hyperfluorescence
case_images: MEAJO-30-51-g001.jpg
case_images: PMC10903715_01_MEAJO-30-51-g001.jpg
case_images: meajo_127_23-f001
case_images: Fundus examination of the left eye showed clear vitreous, prominent ONH swelling with splinter hemorrhages around the disc with a large area of exudative retinal detachment involving the peripapillary area and multifocal choroiditis with macular thickening [Figure 1a and b]. Fundus Fluorescein Angiography (FFA) showed prominent leakage and staining at the ONH [Figure 1c]. ICG angiography (ICGA) disclosed choroidal hypofluorescent oval and round lesions corresponding to granulomas as well as geographic hypofluorescent patches corresponding to choriocapillaritis. ICG choroidal involvement was more widespread than what was seen clinically [Figure 1d and e].
case_images: PMC10903715_02
case_images: (a) At presentation, a color fundus photograph of the right eye shows a large optic nerve head (ONH) granuloma with multiple intraretinal hemorrhages and subretinal exudation. (b) Seven days after starting antituberculous therapy combined with oral prednisolone with no significant reduction in the granuloma size. (c) Four days after intravitreal bevacizumab, a significant decrease in granuloma size and resolution of subretinal exudations was noted. (d) Nine weeks later, a complete resolution of the granuloma and subretinal exudation with a subretinal scar. Corresponding spectral-domain optical coherence tomography of macular area comparing subretinal exudation at presentation (e), 1 week after antituberculous therapy combined with oral prednisolone (f), 4 days after intravitreal bevacizumab (g), and 9 weeks later (h). (i and j) indocyanine green angiography showing large hypofluorescent dark lesion with satellite hypofluorescent dark dots representing choroidal granulomas. Furthermore, note the ONH hyperfluorescence
case_images: MEAJO-30-51-g002.jpg
case_images: PMC10903715_02_MEAJO-30-51-g002.jpg
case_images: meajo_127_23-f002
case_images: Posterior segment examination of the right eye revealed a clear vitreous, prominent ONH infiltrative lesion with massive peripapillary exudative retinal detachment and serpiginous-like choroiditis involving the macula [Figure 2a and e]. ICGA showed oval and round hypofluorescent dark dots suggestive of choroidal granulomas and large hypofluorescent area corresponding to serpiginous-like choroiditis suggestive of inflammatory choriocapillaropathy [Figure 2i and j]. One week later, [Figure 2b and f]; intravitreal bevacizumab 1.25 mg/0.1 mL was administered as subretinal fluid was not resolving. Four days after intravitreal bevacizumab injection, a significant reduction in the granuloma size was noted [Figure 2c and g], and her BCVA improved to 20/400 in the right eye. Total resolution of the ONH infiltration and choroidal involvement with a significant residual chorioretinal scar was noted 9 weeks later [Figure 2d and h].
case_images: PMC10903715_03
case_images: (a and b) Color fundus photograph of the right eye shows a large optic nerve head (ONH) granuloma with a macular star and peripapillary subretinal fluid. (c) Corresponding spectral-domain optical coherence tomography of the macular area with large sensorineural retinal detachment. (d) Fundus fluorescein angiography (FFA) at late venous phase showing diffuse disc leakage and early pooling of fluorescein at the peripapillary area. (e) Color fundus photograph of the left eye showing resolution of the ONH lesion, with few macular exudates and nasal internal limiting membrane folds
case_images: MEAJO-30-51-g003.jpg
case_images: PMC10903715_03_MEAJO-30-51-g003.jpg
case_images: meajo_127_23-f003
case_images: ONH swelling, star-shaped macular exudates, and diffuse subretinal fluid around the ONH involving the macula with peripapillary multifocal choroiditis [Figure 3a and b]. Ocular coherence tomography macula was significant for subretinal fluid [Figure 3c]. Fundus fluorescence angiography (FFA) showed prominent ONH leakage and staining [Figure 3d].