case_images: PMC10754639_01
case_images: Multimodal imaging at initial presentation. (a, b) Fundus photograph of both eyes shows mild narrowing of the retinal arterial vessels and an ovoid elevation of the retina in the left eye ((b), white arrow). (c, d) Fundus autofluorescence of both eyes demonstrates small patches of hypoautofluorescence surrounded by a ring of hyperautofluorescence scattered in the macular region (white arrowheads).
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case_images: PMC10754639_01_CRIOPM2023-9931794.001.jpg
case_images: fig1
case_images: Fundus examination revealed mild narrowing of the retinal arterial vessels and scarce vitreous cells (according to vitreous cell grading scale used in the Multicenter Uveitis Steroid Treatment Trial: score 0.5+) bilaterally (Figures 1(a) and 1(b)). Fundus autofluorescence presented with bilateral small patches of hypoautofluorescence surrounded by a ring of hyperautofluorescence scattered in the macular region (Figures 1(c) and 1(d)).
case_images: (a, b) Early phase of combined fluorescein and indocyanine angiographic examination illustrates choroidal congestion without signs of hyperpermeability or hypofluorescent areas. (c, d) Late phase of combined fluorescein and indocyanine angiographic examination shows discrete extravascular fluorescence (white arrowheads) without signs of retinal vasculitis or loss of choroidal vascular details in both eyes.
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case_images: PMC10754639_01_CRIOPM2023-9931794.002.jpg
case_images: fig2
case_images: Combined fluorescein and indocyanine angiographic examination only showed, in the early phase, choroidal congestion and, in the late phase, discrete extravascular fluorescence without signs of retinal vasculitis or loss of choroidal vascular details in both eyes (Figure 2).
case_images: SD-OCT of the macula at initial presentation. (a, b) SD-OCT demonstrates pachychoroidal changes (choroidal thickness of 505 mum in the right eye and 510 mum in the left eye) with discrete choroidal folds (white arrowheads) and subretinal fluid bilaterally, typically seen in immune checkpoint inhibitor- (ICI-) induced Vogt-Koyanagi-Harada- (VKH-) like uveitis. The most distinctive finding in this OCT assessment is the bacillary layer detachment with a dissection of the photoreceptor inner and outer segment in both eyes (white star), apparently more extensive in the right eye.
case_images: CRIOPM2023-9931794.003.jpg
case_images: PMC10754639_01_CRIOPM2023-9931794.003.jpg
case_images: fig3
case_images: OCT demonstrated pachychoroidal changes (choroidal thickness of 505 mum in the right eye and 510 mum in the left eye) with discrete choroidal folds and subretinal fluid bilaterally, typically seen in immune checkpoint inhibitor- (ICI-) induced Vogt-Koyanagi-Harada- (VKH-) like uveitis (Figure 3). However, the most distinctive finding in the OCT assessment was the bacillary layer detachment (BALAD) with a dissection of the photoreceptor inner and outer segment in both eyes, apparently more extensive in the right eye (Figure 3).
case_images: Multimodal imaging eight days after initial presentation. (a, b) Fundus photograph of both eyes shows improvement with a rapid response to methylprednisolone and complete resorption of the subretinal fluid. (c, d) Fundus autofluorescence of both eyes shows alterations with increase in small patches of hypoautofluorescence surrounded by a ring of hyperautofluorescence scattered in the macula (white arrowheads).
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case_images: PMC10754639_01_CRIOPM2023-9931794.004.jpg
case_images: fig4
case_images: After eight days (Figures 4 and 5), ocular examination revealed slight improvement of clinical findings with a BCVA of 0.7 logMAR in the right and 0.6 logMAR in the left eye.
case_images: SD-OCT of the macula eight days after initial presentation. (a, b) SD-OCT demonstrates pachychoroidal changes (choroidal thickness of 495 mum in the right eye and 490 mum in the left eye) with discrete alterations of the retinal pigment epithelium (RPE) (white arrow) and photoreceptor damage (white arrowheads) with ellipsoid zone disruption (white arrowheads) in both eyes.
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case_images: PMC10754639_01_CRIOPM2023-9931794.005.jpg
case_images: fig5
case_images: After eight days (Figures 4 and 5), ocular examination revealed slight improvement of clinical findings with a BCVA of 0.7 logMAR in the right and 0.6 logMAR in the left eye. OCT-imaging pointed towards photoreceptor damage and ellipsoid zone disruption probably due to the ocular toxicity of nivolumab and ipilimumab (Figure 5).
case_images: SD-OCT of the macula four weeks after initial presentation. (a, b) SD-OCT demonstrates pachychoroidal changes with photoreceptor damage (white arrowheads) and ellipsoid zone disruption (white arrowheads) in both eyes.
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case_images: PMC10754639_01_CRIOPM2023-9931794.006.jpg
case_images: fig6
case_images: Further follow-ups were conducted after four (Figure 6) and 14 weeks (Figures 7 and 8) and demonstrated clinically stable findings with a decrease in choroidal thickness to 420 mum in the right eye and to 480 mum in the left eye (Figure 8), as well as unchanged BCVA with 0.6 logMAR in both eyes at the final visit.
case_images: Multimodal imaging 14 weeks after initial presentation. (a, b) Fundus photograph of both eyes shows stable findings compared to clinical presentation 8 days after the initial examination. (c, d) Fundus autofluorescence of both eyes shows a decrease and consolidation of small patches of hypoautofluorescence surrounded by a ring of hyperautofluorescence scattered in the macula compared to the findings 8 days after initial presentation (white arrowheads).
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case_images: PMC10754639_01_CRIOPM2023-9931794.007.jpg
case_images: fig7
case_images: Further follow-ups were conducted after four (Figure 6) and 14 weeks (Figures 7 and 8) and demonstrated clinically stable findings with a decrease in choroidal thickness to 420 mum in the right eye and to 480 mum in the left eye (Figure 8), as well as unchanged BCVA with 0.6 logMAR in both eyes at the final visit.
case_images: SD-OCT of the macula 14 weeks after initial presentation. (a, b) SD-OCT demonstrates pachychoroidal changes (choroidal thickness of 420 mum in the right eye and 480 mum in the left eye) with photoreceptor damage (white arrowheads) and ellipsoid zone disruption (white arrowheads) in both eyes.
case_images: CRIOPM2023-9931794.008.jpg
case_images: PMC10754639_01_CRIOPM2023-9931794.008.jpg
case_images: fig8
case_images: Further follow-ups were conducted after four (Figure 6) and 14 weeks (Figures 7 and 8) and demonstrated clinically stable findings with a decrease in choroidal thickness to 420 mum in the right eye and to 480 mum in the left eye (Figure 8), as well as unchanged BCVA with 0.6 logMAR in both eyes at the final visit.