Primary Inflammatory Choriocapillaropathy Rupesh Agrawal, Carlos Pavesio Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
Ocular History 24 year old, male, Asian 24 year old, male, Asian RE: complaints of small scotomas since few months, RE: complaints of small scotomas since few months, Ocular history: Non-significant Ocular history: Non-significant
General History History of TB exposure History of TB exposure no other history of preceding viral illness no other history of preceding viral illness
First Presentation OD: VA: RE- 6/12, LE- 6/6 SLE: AC – no cells, no flare, lens clear no vitreous cells no retinitis or vasculitis color vision: Normal no RAPD OS: normal
First Presentation - OD: Fundus, FFA, ICGA serpiginoid coalescing lesions on fundus photograph FFA: hyperfluorescent lesions on early phase becoming more hyperfluorescence in late phase blocked fluorescence on ICGA, also showing presence of blocked high resolution, high magnification Fluorescence of the lesion using FFA
First Presentation – Autofluorescence OD hyperfluorescence involving fovea
First Presentation - Spectralis OCT OD: loss of inner segment /outer segment photoreceptor layer in the foveal and parafoveal region OS: normal OCT
First Presentation - Spectralis OCT and IR OD loss of inner segment /outer segment photoreceptor layer with intraretinal fluid
Diagnosis Atypical Acute placoid multifocal posterior pigment Epitheliopathy or Atypical Ampiginous choroiditis or Atypical relentless placoid pigment epitheliopathy based on clinical findings FFA, ICGA features Autofluorescence
Treatment as involving visual axis – treated with oral steroids 60mg/day for 1week in tapering dose blood tests: routine tests: normal Quantiferon-Gold & syphillis: negative
Follow up – After 1 weeks resolving lesion in the OD VA: OU- 6/5 treatment – tapering steroids every week and stopped after six weeks
Follow up – After One week Autofluorescence OD Lesion resolving
Follow up – After 1 week OCT and IR significant resolution of the lesion
Final follow up – After 4 Months no recurrence of the lesion no recurrence of the lesion VA: OU: 6/5 VA: OU: 6/5 no cells, no flare. no cells, no flare. scarred lesion parafoveal and normal AF scarred lesion parafoveal and normal AF