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case_images: Case 1, right eye (OD). (A): Ultra-widefield pseudocolor fundus photography demonstrates numerous, subtle peripheral white dots, some coalescing into larger spots, possibly into placoid lesions. (B): Lase-phase fluorescein angiography demonstrates optic nerve head leakage centrally. (C): Fundus autofluorescence colocalizes with greater clarity the scattered white dots seen on fundus examination as discrete regions of hyperautofluorescence (arrows). (D): Swept-source optical coherence tomography did not show evidence of retinal pigment epithelium or ellipsoid zone disruption in the macula.
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case_images: On dilated examination, 1+ vitreous cell was noted in the right eye, and subtle white spots were found in the periphery, right greater than the left eye, without the presence of any placoid lesions (Figure 1A and Figure 2A). FA showed active leakage from the optic nerve head in both eyes (Figure 1B and Figure 2B). OD (Figure 1C) and inferonasally OS (Figure 2C). OCT did not demonstrate evidence of RPE or ellipsoid zone disruption in the macula; however, peripheral scans were not obtained in areas of involvement (Figure 1D and Figure 2D).
case_images: Case 1, left eye (OS). (A): Ultra-widefield fundus pseudocolor photography shows nearly invisible peripheral white spots, fewer in number than the fellow eye, yet without placoid lesions. (B): Late-phase fluorescein angiography demonstrates active optic nerve head leakage. (C): Fundus autofluorescence colocalizes with the white dots seen on fundus examination as discrete foci of hyperautofluorescence (arrows). (D): Swept-source optical coherence tomography of the macula did not show evidence of retinal pigment epithelium or ellipsoid zone disruption.
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case_images: On dilated examination, 1+ vitreous cell was noted in the right eye, and subtle white spots were found in the periphery, right greater than the left eye, without the presence of any placoid lesions (Figure 1A and Figure 2A). FA showed active leakage from the optic nerve head in both eyes (Figure 1B and Figure 2B). OD (Figure 1C) and inferonasally OS (Figure 2C). OCT did not demonstrate evidence of RPE or ellipsoid zone disruption in the macula; however, peripheral scans were not obtained in areas of involvement (Figure 1D and Figure 2D).
case_images: PMC11817950_02
case_images: Case 2, right eye (OD). (A): Ultra-widefield pseudocolor fundus photography showed retinal pigment epithelium changes and sclerotic vessels temporally. (B): Fluorescein angiography demonstrated leakage at the optic nerve head and hyperfluorescence corresponding to the areas of retinal pigment epithelial changes seen on dilated exam. (C): Fundus autofluorescence revealed a large placoid lesion with neighboring coalesced and isolated dots and spots of hyperautofluorescence (arrow). (D): Swept-source optical coherence tomography of the macula showed evidence of disruption to the ellipsoid zone and retinal pigment epithelium/Bruch membrane with an outer retinal hyperreflective lesion (arrow).
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case_images: The macula showed retinal pigment epithelial changes, ghost vessels, and perivascular sheathing temporally (Figure 3A). IVFA demonstrated leakage at the optic nerve head and hyperfluorescence corresponding to the areas of retinal pigment epithelial changes seen on dilated exam (Figure 3B). UWFAF revealed a hyperautofluorescent placoid lesion with coalesced dots and spots of hyperautofluorescence in the macula that extended past the optic nerve head (Figure 3C). OCT macula showed evidence of hyperreflective opacities consistent with vitreous inflammation, as well as disruption and attenuation of the ellipsoid zone adjacent to the outer retinal hyperreflective lesion (arrowed site in Figure 3D).
case_images: Resolution of outer retinal disruption and white dots and spots are seen after systemic treatment of syphilis in Case 2. (A): Ultra-widefield pseudocolor fundus photography reveals resolution of the coalesced white dots following penicillin administration. (B): Fundus autofluorescence demonstrates nearly complete resolution of hyperfluorescence. (C): Swept-source optical coherence tomography of the macula shows improvement in the outer retinal architecture (arrow), including adjacent areas of prior ellipsoid zone disruption. Insets compare respective imaging from initial presentation to show improvement following treatment.
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case_images: One month after treatment with intravenous penicillin G (24 million units/per day for 14 days), there was an improvement in symptoms and chorioretinal lesions (Figure 4). UWFAF appears to demonstrate resolution of both the coalesced and isolated white dots (Figure 4B) with greater clarity than ultra-widefield CFP (Figure 4A). OCT macula also revealed improvement to the ellipsoid zone architecture in the right eye (Figure 4C).
case_images: PMC11817950_03
case_images: Case 3, right eye (OD). (A): Ultra-widefield pseudocolor fundus photography reveals vascular attenuation and retinal pigment epithelial changes in addition to subtle white dots and spots, some coalesced. (B): Fluorescein angiography demonstrates leakage consistent with active vasculitis. (C): Fundus autofluorescence shows numerous scattered dots of hyperautofluorescence extending into the periphery and adjacent to a macular placoid lesion (arrows). (D): Swept-source optical coherence tomography showed a conical, outer foveal hyperreflective lesion extending from retinal pigment epithelium/Bruch membrane and disrupting ellipsoid zone as well as a thickened choroid. Several other foci of ellipsoid zone disruption are also observed (arrows).
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case_images: A complete ophthalmic examination revealed trace cells in the vitreous, diffuse retinal vessel attenuation, and central and temporal RPE changes in both eyes (Figure 5A and Figure 6A). IVFA demonstrated late leakage of the optic nerve and vascular leakage consistent with active vasculitis in both eyes (Figure 5B and Figure 6B). UWFAF showed bilateral placoid lesions with hyperautofluorescence most prominent in the temporal macula extending into the temporal periphery in the right eye (Figure 5C) and numerous, eccentric small dots and spots in the left eye (Figure 6C). OCT showed ellipsoid zone and RPE/Bruch membrane disruption from an elevated, outer retinal hyperreflective lesion in the fovea of the right eye (Figure 5D) and a spared left macula (Figure 6D).
case_images: Case 3, left eye (OS). (A): Ultra-widefield pseudocolor fundus photography reveals subtle, small whitish lesions throughout the fundus with vascular attenuation and retinal pigment epithelial changes. (B): Fluorescein angiography demonstrated leakage of the optic nerve and vascular leakage consistent with active vasculitis. (C): Fundus autofluorescence demonstrated scattered dots of hyperautofluorescence including a placoid lesion in the periphery (arrows). (D): Swept-source optical coherence tomography showed a thickened choroid without any outer retinal disruption in the central macula.
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case_images: A complete ophthalmic examination revealed trace cells in the vitreous, diffuse retinal vessel attenuation, and central and temporal RPE changes in both eyes (Figure 5A and Figure 6A). IVFA demonstrated late leakage of the optic nerve and vascular leakage consistent with active vasculitis in both eyes (Figure 5B and Figure 6B). UWFAF showed bilateral placoid lesions with hyperautofluorescence most prominent in the temporal macula extending into the temporal periphery in the right eye (Figure 5C) and numerous, eccentric small dots and spots in the left eye (Figure 6C). OCT showed ellipsoid zone and RPE/Bruch membrane disruption from an elevated, outer retinal hyperreflective lesion in the fovea of the right eye (Figure 5D) and a spared left macula (Figure 6D).