Inflammatory choroidal neovascularization Sana Khochtali, MD Wafa Ammari, MD Samah Mbarek, MD Riadh Messaoud, MD Department of ophthalmology Fattouma Bourguiba University Hospital Tahar Sfar University Hospital Faculty of Medicine, University of Monastir, Monastir, Tunisia

Ocular History A 16-year-old girl February 2011 : vision blurring, toxoplasmic retinochoroiditis OS treated with azithromycin by local ophthalmologist August 2011: vision loss, OS

August 2011 Visual acuity 20/20 OD, 20/200 OS No AC inflammatory reaction OS Intraocular pressure : 15 mmHg OU 1+ vitreous cells, no vitreous haze OS OD : unremarkable

Fundus photograph shows an atrophic chorioretinal scar (arrow), and a slightly prominent grayish lesion (arrowhead), superotemporal to the fovea The patient was diagnosed as having active recurrent toxoplasmic retinochoroiditis The patient was treated with the association of pyrimethamine, azithromycin, and oral prednisone

One month later Visual acuity: 20/200, same fundus findings

Fluorescein Angiography B Early-phase fluorescein angiogram (A) shows hyperfluorescent, well-defined juxtafoveal choroidal neovascular membrane surrounded by retinal hemorrhages. Late-phase fluorescein angiogram (B) shows a profuse leakage from the neovascular membrane

Optical Coherence Tomography OCT showed a fusiform thickening of the RPE-choriocapillaris band, corresponding to the choroidal neovascular membrane (arrow), associated with the presence of intraretinal fluid

Final diagnosis Inflammatory choroidal neovascularization secondary to ocular toxoplasmosis The patient received a single intravitreal injection of bevacizumab (1.25 mg)

Follow-up Visual acuity: 20/32 Resorption of the intraretinal fluid (OCT) At 18-month follow-up : no recurrence of the choroidal neovascularization OCT shows a subretinal hyperreflective dome-like lesion without intraretinal fluid, consistent with inactive scar

Conclusion The diagnosis of inflammatory choroidal neovascularization secondary to ocular toxoplasmosis may be challenging Careful clinical examination, fluorescein angiography and OCT provide clues for the definitive diagnosis A single intravitreal anti-VEGF injection (without anti-toxoplasmic medications) may be sufficient to control neovascularization