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A 24-year-old woman with sudden-onset, unilateral vision loss
Digital Journal of Ophthalmology 2019
Volume 25, Number 4
November 17, 2019
DOI: 10.5693/djo.03.2019.09.004
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Parisa Khalili | Al Zahra Eye Hospital, Zahedan University of Medical Sciences, Zahedan, Iran; Nazanin Ebrahimi Adib | Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran Hassan Khojasteh Jafari | Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran Reza Shamsi | Al Zahra Eye Hospital, Zahedan University of Medical Sciences, Zahedan, Iran; Shima Dehghani | Al Zahra Eye Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
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| Differential Diagnosis | Macular serpiginous choroiditis, tuberculous serpiginous-like choroiditis (SLC), and persistent placoid maculopathy were our primary concerns in the differential diagnosis for this patient. Macular serpiginous choroiditis involves the macular area early in its clinical course, similar to what we observed in our patient. Lesions commonly leave areas of obvious chorioretinal scarring and atrophy once they become inactive. Additionally, it is reported that the near infrared imaging will show a distinctive hyper-reflective line at the margin of the active and inactive lesion, which gets disrupted as the lesion transforms to an inactive lesion.(1) Moreover, on foveal involvement, the visual prognosis is poor, and visual acuity does not improve significantly as the lesion progresses to chorioretinal scarring; choroidal neovascularization can be seen in up to 35% of cases.(2) Unlike previous reports, visual acuity improved significantly in our case. Near-infrared imaging was not available in our case. SLC appears with multifocal, unilateral, irregular lesions and fingerlike projections, is commonly accompanied with vitreous and anterior chamber reaction,(3) and foveal involvement renders a poor visual prognosis.(2,4) There were no cells in the anterior chamber nor vitreous in our patient, and the lesion had a solitary appearance. Finally, patients with persistent placoid maculopathy have multiple bilateral lesions, whereas our patient had a macular lesion only in her left eye.(5)
We also considered acute idiopathic maculopathy (AIM) and acute retinal pigment epithelitis (ARPE), because they can also appear with sudden-onset unilateral vision loss in young patients who experience full visual recovery.(6,7) They can also be preceded by a flulike illness, which did not occur in our patient. Additionally, the fundus findings and imaging for our patient were not entirely consistent with AIM, in which circumscribed grayish pigmentary changes are usually seen in the macular region in the active phase, becoming more like a bull’s eye on recovery.(7,8) Also, OCT findings in AIM include hyper-reflective thickening of the outer retina and RPE in the foveal region, sometimes accompanied by hyper-reflective exudation and hyporeflective fluid in the subretinal space and neurosensory detachment. On FA, AIM patients usually exhibit an early irregularly speckled hyperfluourescence and hypofluorescence in the area of the active lesion that may be followed by dye pooling in the region of subretinal fluid, if present, in the late phase.(7,8) The lesion in our patient showed expansion on FA in the 4th week and was not compatible with angiographic features of AIM. Our case was also not fully similar to usual cases of ARPE in terms of the morphology of the lesion and FA findings. | |
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