case_images: PMC11747723_01
case_images: Summary of treatment and duration of treatment leading up to stem cell transplant, and secondary autoimmune diseases after.
case_images: fimmu-15-1484798-g001.jpg
case_images: PMC11747723_01_fimmu-15-1484798-g001.jpg
case_images: f1
case_images: The patient had received numerous immune-modulatory treatments prior to presenting to our center ( Figure 1 ). As there continued to be features of disease activity despite 6 months of immunosuppressive treatment, electrophysiological examination was performed at presentation ( Figure 3 , row 1), and repeated 2 months later ( Figure 3 , row 2).
case_images: En face fundus images (A-D) and cross-sectional optical coherence tomography b-scan (E-H) of the macula of both eyes before and after autologous hematopoietic stem cell transplant. (A, B) Peripheral vascular sheathing was present in both eyes (magnified insert). (C, D) Resolution of the peripheral vascular sheathing 3 months after transplant. (E, G) Hyper-reflective dots within the retina and on the retinal surface (white circles) resolved after transplant accompanied by improvement in reflectivity from the ellipsoid zone corresponding to the photoreceptors (solid arrowhead). (F, H) Improvement in reflectivity from the ellipsoid zone was similarly present in the left eye 3 months after transplant.
case_images: fimmu-15-1484798-g002.jpg
case_images: PMC11747723_01_fimmu-15-1484798-g002.jpg
case_images: f2
case_images: The fundus appearance and OCT imaging on presentation to our center are shown in  Figure 2 . As there continued to be features of disease activity despite 6 months of immunosuppressive treatment, electrophysiological examination was performed at presentation ( Figure 3 , row 1), and repeated 2 months later ( Figure 3 , row 2).
case_images: Serial electrophysiological tests performed before (rows 1 and 2) and after the autologous stem cell transplant (row 3). Shown are Standard ERGs as recommended by the International Society for Electrophysiology of Vision. DA = dark adapted; LA = light adapted; the numbers indicate stimulus strength in cd.s/m2.The ERGs after 6 months of immunosuppression (24 May 2022, row 1) and repeated 10 days prior to her transplant (12 Aug 2022, row 2) show bilateral generalized retinal cone system dysfunction and severe delay (LA 30 Hz, peak time delay indicated by the interrupted lines). There had been minimal improvement during that time despite ongoing treatment. In addition, in the right eye, the b-wave of the DA 10.0 response showed an abnormal bifid waveform (circled). The LA 30 Hz ERGs 3 months after her transplant (15 November 2022, row 3) show substantial improvement in the delay in the right eye, and normalization in the left eye. There is additional resolution of the abnormal bifid waveform in the DA10.0 of the right eye (circled) to the waveform present in the normal subject (N). Data from a representative normal subject appear for comparison in the lower row (N).
case_images: fimmu-15-1484798-g003.jpg
case_images: PMC11747723_01_fimmu-15-1484798-g003.jpg
case_images: f3
case_images: As there continued to be features of disease activity despite 6 months of immunosuppressive treatment, electrophysiological examination was performed at presentation ( Figure 3 , row 1), and repeated 2 months later ( Figure 3 , row 2).