top of page

Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.

On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.

A dilated fundus examination was performed demonstrating the following:

OCTcases (logo1).png

Uveitis

Case 13

Patient Presentation: A 61-year-old Caucasian man was referred to a uveitis clinic for atypical retinal findings OU. The patient was being treated for neovascular age-related macular degeneration for the previous 2 years. He was initially diagnosed with dry AMD due to peripapillary drusenoid changes, but after 1 year of monitoring, he developed choroidal neovascularization. The referring retinal specialist was concerned for the progression of RPE changes in the peripapillary region. The choroidal neovascularization was quiescent after 4 intravitreal anti-VEGF injections at the time of presentation.

The patient noted decreased vision over the last 6 months with floaters OS > OD. He denied flashes, visual field deficit, and trauma. He denied any past medical or ocular history. Review of systems was negative. His visual acuity was 20/100 OD and CF OS. IOP was within normal limits and there was no RAPD. Fundus photos and fundus autofluorescence images were taken and are shown below:

Question 1: What are the main findings in the fundus photos and fundus autofluorescence images above?

Click Here for Answer

OCT macula images were taken and are shown below:

Question 2: What are the main findings in the OCT macula images above?

A. Intra- and subretinal hyper-reflectivity

B. Subretinal fluid

C. Disorganization of the inner retinal layers

D. Choroidal neovascularization

Intravenous fluorescein angiography imaging was then conducted. Below is the early and late phase of the right eye, and the late phase of the left eye:

IVFA imaging demonstrates early hypofluorescence with late hyperfluorescence around the edges of the lesions.

Question 3: Based on the fundus findings, FAF, IVFA, and OCT imaging, what is the most likely diagnosis?

A. Birdshot chorioretinopathy

B. Serpiginous chorioretinopathy

C. Acute posterior multifocal placoid pigment epitheliopathy

D. Ocular histoplasmosis syndrome

Question 4: What is the most appropriate treatment for this condition?

B. Urgent vitrectomy

C. Intravitreal anti-VEGF injections

D. Systemic steroids with long term immunomodulatory therapy

Learning Objectives:

Understand the typical imaging findings of serpiginous chorioretinopathy
Learn the typical treatment options for serpiginous chorioretinopathy

bottom of page