case_images: PMC11832258_01
case_images: (a) OS fundus image showing frosted branch angiitis involving first-order vessels of all quadrants with fluffy perivascular exudation in the superior quadrant without any significant vitritis suggestive of progressive outer retinal necrosis with frosted branch angiitis. (b) OS fundus image of posttreatment phase showing resolution of perivascular sheathing from all quadrants except in the superior quadrant along with reduction in perivascular exudation.
case_images: CRIOPM2025-8844545.001.jpg
case_images: PMC11832258_01_CRIOPM2025-8844545.001.jpg
case_images: fig1
case_images: Based on clinical findings, it was diagnosed as Type 2 FBA with PORN in the OS (Figure 1(a)). T cell levels dropped to 91 cells/muL. The serum angiotensin-converting enzyme (ACE) levels and erythrocyte sedimentation rate (ESR) were elevated (Figure 1(b)).
case_images: PMC11832258_02
case_images: (a) Sectoral fundus image showing peripheral area in the OD with frosted branch-like appearance of vessels and diffuse intraretinal hemorrhage as seen usually in Type 3 Kleiner's variety of frosted branch angiitis. (b) OS fundus image showing posterior fundus with perivascular sheathing involving multiple vessels in all quadrants.
case_images: CRIOPM2025-8844545.002.jpg
case_images: PMC11832258_02_CRIOPM2025-8844545.002.jpg
case_images: fig2
case_images: Type 3 FBA and treated with empirical valaciclovir 1000 mg thrice daily and prednisolone 40 mg/day. The child was vigilantly monitored (Figures 2(a) and 2(b)).
case_images: PMC11832258_03
case_images: (a) Fundus image of OS posterior pole showing extensive perivascular exudation along the vessels in all quadrants on presentation. (b) After treatment, all the exudation has resolved and the posterior pole appears within normal limits.
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case_images: PMC11832258_03_CRIOPM2025-8844545.003.jpg
case_images: fig3
case_images: Fundus examination revealed venous tortuosity with translucent retinal perivascular infiltration predominantly affecting venules from the posterior pole to the periphery in the OS (Figure 3(a)). The fellow eye was unaffected (Figure 3(b)).
case_images: (a) Wide-angled fundus image of OS posterior pole showing extensive perivascular exudation along the vessels in all quadrants on presentation. (b-d) Wide-angled FFA showing perivascular hyperfluorescence indicating perivascular sheathing and widespread areas of peripheral capillary nonperfusion as hypofluorescent areas.
case_images: CRIOPM2025-8844545.004.jpg
case_images: PMC11832258_03_CRIOPM2025-8844545.004.jpg
case_images: fig4
case_images: FFA showed hyperfluorescence along the venules in all quadrants with peripheral CNP areas without any signs of late leakage (Figures 4(a), 4(b), 4(c), and 4(d)).
case_images: PMC11832258_04
case_images: (a) Fundus image of the OD shows extensive, opaque, interrupted perivascular sheathing involving first-order vessels with superficial intraretinal hemorrhage involving inferotemporal quadrant suggestive of Type 2 Kleiner's variety of frosted branch angiitis. Another unique feature noted was the preretinal fluffy exudates over the posterior pole supporting intravitreal involvement of frosted branch angiitis in cases with excessive exudation. Along with this, benign flecks were noted all over the fundus. (b) Fundus image of the OS shows similar features as seen in the OD, although intraretinal hemorrhage was absent. Preretinal exudative clumps and benign flecks were also noted. (c) Fundus fluorescent image showing perivascular hyperfluorescence indicating leakage and exudation and blocked fluorescence over inferotemporal quadrant that corresponds to superficial intraretinal hemorrhage. (d) Similar to image (c). Fundus fluorescent angiography in the OS shows perivascular hyperfluorescence in all quadrants although the involvement is patchier and more discreet and a small area of temporal peripheral capillary nonperfusion. (e) Posttreatment fundus image of the OD showing resolution of frosted branched appearance with reduction in intraretinal hemorrhage but persistence of preretinal exudates. (f) Posttreatment montage fundus photography of the OS elaborates on 360  flecks over the retina with complete resolution of perivascular exudation and incomplete resolution of preretinal exudative clumps.
case_images: CRIOPM2025-8844545.005.jpg
case_images: PMC11832258_04_CRIOPM2025-8844545.005.jpg
case_images: fig5
case_images: It was also noted that the exudates not only were intraretinal but also involved the posterior hyaloid face (Figures 5(a) and 5(b)). FFA showed contiguous, granular, and opaque perivascular sheathing in the OD, compared to the OS in which sheathing was more discrete and it has a beaded appearance (Figures 5(c) and 5(d)). There was no recurrence till her last follow-up visit, which was 6 months since the initial presentation (Figures 5(e) and 5(f)).