case_images: PMC11834925_01
case_images: OCT scan passing through the lesion superior to the disc shows thickened nerve fiber layers, subretinal fluid (SRF), and choroidal thickening (a). Choroidal undulations and disorganization of overlying retinal layers are evident (b). Bands of vertical hyper-reflective lesion (arrows) layers are also appreciated in the outer nuclear layer (c), (d)
case_images: IJO-73-2-g001.jpg
case_images: PMC11834925_01_IJO-73-2-g001.jpg
case_images: IJO.IJO_894_24-F1
case_images: Optical coherence tomography (OCT) confirmed the above findings and revealed choroidal thickening [Fig. 1a]. OS [Fig. 2a]. OCT showed an increase in choroidal thickening superior to the disc [Fig. 1b]. In addition, it also revealed vertical hyper-reflective strips(VHRS) in the outer retina (arrows), confirming retinal involvement [Fig. 1c and d].
case_images: Widefield fundus photo (OptosTM) shows disc hyperemia, multiple yellowish choroidal lesions superiorly and nasally to the disc (arrows), and subtle yellowish lesions in the peripheral retina (thin arrow) (a). Wide-spread retinal hemorrhage, sclerosed vessels, and large plaques of peripheral retinitis show established ARN (b). FA showed disc leakage, vasculitic leakage (arrow), and subtle hypofluorescent lesions nasally and superiorly to the disc (thin arrow) (c), suggestive of choroiditis, as confirmed on ICG (d). Widefield fundus photo (OptosTM) shows resolved retinitis in both eyes (e, f)
case_images: IJO-73-2-g002.jpg
case_images: PMC11834925_01_IJO-73-2-g002.jpg
case_images: IJO.IJO_894_24-F2
case_images: OS [Fig. 2a]. OCT showed an increase in choroidal thickening superior to the disc [Fig. 1b]. FA-ICG revealed vasculitis components, confirmed choroidal involvement, and showed the extent of lesion [Fig. 2c and d]. After 5 days, his BCVA dropped to light perception as OS developed classical ARN along with hemorrhagic vasculitis [Fig. 2b] Polymerase chain reaction (PCR) from aqueous came positive for VZV, and blood workup was negative for baseline uveitis investigations (HIV, TPHA, Toxoplasma serology, Mantoux). OU [Fig. 2e and f]. Oral famciclovir then tapered to 500 mg TID for 2 1/2 months, then 500 mg BD for 3 months, and then OD for 1 month.