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Background: Idiopathic scleroma (previously coined solitary idiopathic choroiditis or focal scleral nodule) is an innocuous lesion affecting the sclera with intraocular manifestations. It is often the basis of many misdiagnoses such as amelanotic choroidal melanoma, osteoma or metastatic lesions. Patients are often asymptomatic and the course is benign. With increasing use of community based imaging, more of such cases are being identified. This paper is a retrospective case series investigating the multi-modal imaging findings of idiopathic scleroma., Methods: A retrospective analysis of prospectively collected data were analysed. Over the course of January 2008-January 2022, 44 patients diagnosed with idiopathic scleroma and imaged with wide-field colour fundus photography, fundus autofluorescence, ocular coherence tomography (OCT) and B-scan ultrasonography. Due to a poor image, only 43 images were included for OCT review. We also reviewed our patient's demographics, symptoms and baseline ophthalmic characteristics upon presentation., Results: The mean age was 52 years (range 32-79) and there was no predilection towards gender. All lesions were post equatorial with the most common location being inferotemporal (n = 16, 36%); 32 lesions (73%) were yellow on fundus photography. 82% (n = 36/44) of lesions exhibited hyperautoflourescence and 43 lesions (98%) showed hyperechogenicity on B-scan ultrasonography. 100% of lesions originated from the sclera with no lesions showing active inflammation. 20 (47%) lesions had associated blood vessels overlying them on OCT., Discussion: Idiopathic scleroma is a yellow, hyperautofluorescent, hyperechogeneic scleral lesion that has no signs of active inflammation. These characteristics help define them from other more sinister cause of amelanotic fundal lesions., (© 2022. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Purpose : To report a case of choroidal neovascularization (CNV), which was not obvious with dye angiography but was detected with optical coherence tomography angiography (OCTA). Methods : A 50-year-old female presented with decreased vision in her right eye. Funduscopic examination revealed a swollen hyperemic disc, peripapillary exudation, and choroidal infiltration. Results : Optical coherence tomography revealed intraretinal cysts, subretinal fluid in the macular region, and subretinal hyperreflective material in the papillomacular area. Fluorescein angiography revealed early hypofluorescence in the areas of choroidal infiltrations, and indocyanine green angiography (ICGA) also showed hypocyanescence corresponding to these infiltrations and revealed a faint hypocyanescence in the papillomacular region, further corresponding to the subretinal hyperreflective material on OCT scan. Two weeks after the initiation of systemic therapy with the diagnosis of tuberculosis, OCTA scans detected Type 1 CNV in the peripapillary area. Conclusion : OCTA may be superior to ICGA in the detection of CNV secondary to inflammatory situations.

Purpose: To analyze and describe serial follow-up of choriocapillaris alterations in tubercular serpiginouslike choroiditis (SLC) using optical coherence tomography angiography (OCTA) and to compare it with multimodal imaging., Methods: In this prospective cohort study, patients with active tubercular SLC underwent OCTA using Optovue RTVue XR Avanti and other imaging techniques including enhanced-depth imaging OCT (EDI-OCT) (Heidelberg Spectralis; Heidelberg Engineering, Heidelberg, Germany), fundus autofluorescence, fluorescein angiography, and indocyanine green angiography. Serial imaging was performed for a total follow-up of 3 months. Choriocapillaris alterations at the site of lesions were analyzed on OCTA imaging, and their mean lesion areas were calculated., Results: Twenty-six eyes (26 patients; 20 males; mean age: 32.68 ± 10.56 years) were included. Fourteen eyes had active multifocal lesions (n = 39), whereas 12 eyes had active placoid lesions (n = 12). At baseline, OCTA showed hyporeflective flow deficit lesions corresponding to the hypofluorescent lesions on indocyanine green angiography in all eyes. In the multifocal type of SLC, the mean lesion area decreased in all eyes compared with baseline, and lesions with a lesion area less than 0.1 mm2 on OCTA showed near-complete resolution with minimal choriocapillaris atrophy. In comparison, all eyes with a placoid type of SLC showed no significant reduction in the lesion area and showed extensive choriocapillaris atrophy., Conclusion: Optical coherence tomography angiography has the unique ability to demonstrate pathological flow impairment at the level of choriocapillaris in active tubercular SLC. Serial OCTA analysis reveals that large tubercular SLC lesions result in choriocapillaris atrophy as the lesions heal, whereas smaller multifocal lesions show resolution of choriocapillaris hypoperfusion with minimal atrophy.

Objective: To summarize the clinical and fundus imaging features of purified protein derivative and T-spot positive tubercular serpiginous-like choroiditis (PTP-SLC) patients. Methods: This retrospective study consecutively enrolled 13 PTP-SLC patients (21 eyes) in Beijing Tongren Hospital from November 2015 to November 2017. There were 8 males and 5 females with an average age of (45.2±12.1) years. Medical history and results of systemic and ophthalmological examinations, such us fundus autofluorescence photography, optical coherence tomography (OCT), fluorescein fundus angiography (FFA) and indocyanine green angiography, were evaluated. Results: Eight patients had binocular disease with an average interval time of (8.4±7.9) years. The average visual acuity of all patients was 0.3, and 4 patients had a clear history of exposure to tuberculosis. The active lesions in the PTP-SLC patients were homogeneous and creamish-yellow with unclear boundaries. Fundus autofluorescence showed an ill-defined, diffuse hyperautofluorescent zone. OCT showed punctate hyperreflexes between the choroidal stroma, destruction of the outer retinal structure with intraretinal edema and discrete vitreal hyper-reflective spots. FFA showed hypofluorescence in the active lesion at early stage and diffuse hyperfluorescence with leakage. Indocyanine green angiography showed persistent hypofluorescence. Conclusions: PTP-SLC fundus lesions are mainly manifested as homogeneous creamish-yellow lesions with unclear boundaries and high in autofluorescence. The involvement of the choroid and the outer layer of the retina can be observed on OCT. FFA can find more retinal vascular inflammatory changes. It is difficult to distinguish PTP-SLC from serpiginous choroiditis simply based on clinical and epidemiological characteristics. The pathogenic examination of tuberculosis is still the key to differential diagnosis (Chin J Ophthalmol, 2020, 56: 914-919) .

Purpose: Ocular tuberculosis has protean clinical manifestations. Because of its varied clinical presentation, multimodal imaging is very important to characterize the disease activity, presence of inflammation, determining therapeutic response, and detection of complications., Methods: Narrative review., Results: In this review, various imaging modalities employed in the management of ocular tuberculosis including fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) have been reviewed. Not only do these imaging tools complement each other in providing a comprehensive assessment of the pathology, they also help in gaining valuable insights regarding the evolution of the disease., Conclusions: Fundus imaging plays a vital role in the diagnosis and management of patients with posterior uveitis due to tuberculosis. Fundus imaging may have a useful role in defining clinical endpoints for ocular tuberculosis in the future.

Competing Interests: None

We here hypothesize the scleral origin of 'Solitary Idiopathic Choroiditis', a yellowish, nodular lesion that resembles other choroidal tumors. Systemic investigations were done to rule out causes like tuberculosis and sarcoidosis. Multimodal imaging was done for better characterization and to distinguish it from other choroidal lesions. Fundus imaging revealed a yellowish-orange, well-defined nodular lesion resembling solitary idiopathic choroiditis inferotemporal to the disc. Swept source optical coherence tomography (SSOCT) showed a nodular lesion arising from the sclera with compression of overlying choroid. Indocyanine green angiography (ICGA) showed hypofluorescence in all phases of angiogram with displacement of major choroidal vessels along the walls of the mass and loss of overlying choriocapillaries. The same was evident on Swept Source optical coherence tomography angiography (SSOCTA) as well. Fundus autofluorescence (FAF) showed central hypofluoresence with surrounding hyperfluorescence. Ultrasound (USG) B scan revealed a high reflective echo at the apex of the mass with moderate internal reflectivity without any evidence of calcification. Enhanced Infrared (IR) Reflectance imaging revealed a central intense hyerreflective area suggestive of a fibrotic mass. Magnetic reasonance imaging (MRI) revealed a focal hypointense nodular lesion on T2-weighted image. The central white area at the apex with corresponding hypoautofluorescence, a high spike on ultrasound, intense hyperreflectivity on enhanced Infrared reflectance, lack of vascularity and displacement of choroidal vessels is suggestive of a scleral origin of the mass and likely fibrotic nature., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Multifocal choroiditis (MFC) is multi-inflammatory lesions that occur in the retinal pigment epithelium (RPE) and the choriocapillaris. Optical examinations are the major diagnostic methods to diagnose the disease., Objective: To examine patients with different types of MFC by multiple imageological methods. To summarize the imageology features of different types of MFC to make a medical examination guideline for clinician practices., Method: All of the patients who included in the study received examinations of fundus color photography, infrared fundus photography, fundus auto fluorescence (FAF), fluorescein fundus angiography (FFA), and optical coherence tomography (OCT), respectively. Finally, imageology features of different types of multifocal choroiditis were summarized., Results: A total of 51 eyes from 28 patients with diagnosed MFC were included in the study. These patients consisted of 10 males and 18 females aged from 31 to 49 (mean age: 41.5 ± 0.8). 23 patients had MFC on both eye whilst 5 had monocular disease. The MFC lesions were classified as active inflammatory lesions, inactive inflammatory lesions, inflammatory lesions secondary active choroidal neovascularization (CNV) and inflammatory lesions secondary inactive CNV according to literature reports and comprehensive fundus imaging examinations., Conclusion: Examinations via fundus color photography, infrared fundus photography, FAF, FFA and OCT indicate typical imageological signals of different types of MFC. These imageology tests can greatly assist the clinicians to identify the MFC and provide proper therapies.

Rationale: Optical coherence tomography angiography (OCT-A) has the advantage to visualize the microvascular structure of the retina in vivo and was utilized clinically in various neovascular retinal diseases. The OCT-A has also been used to examine the lesion in multifocal choroiditis and panuveitis (MCP). This study aimed to describe a case of MCP and present the disease process of a punched-out lesion in the chorioretina with neovascular activity using OCT-A., Patients Concerns: A 32-year-old female Caucasian patient presented with a 2-week history of progressive blurred vision in her right eye with photophobia and a diminished temporal visual field. On presentation, her best corrected visual acuity was 6/60 in the right eye with a prominent anterior uveitis seen under slit lamp examination., Diagnoses: Dilated fundus examination of the right eye showed vitritis and multiple, punched-out yellowish-white lesions over the peripheral retina. Additional multimodal imaging (MMI) were done including fluorescein angiography (FA), indocyanine green angiography (ICGA) and fundus autofluorescence (FAF), which all revealed characteristic findings of MCP. In general, the diagnosis of unilateral MCP was made. Furthermore, one of the punched-out lesions in the right eye was particularly selected and examined under OCT and OCT-A, which revealed a subretinal elevated lesion with high flow signal under OCT-A., Interventions: Treatment with oral prednisolone at 30 mg daily with topical prednisolone acetate 1% every 2 hours were prescribed, which were gradually tapered down within a 2-month course., Outcomes: The patient's best corrected visual acuity of the right eye returned to 6/6 at 2 months after the diagnosis. The flow signal in the OCT-A study of the punched-out lesion had also resolved after steroid treatment., Lessons: The MCP is an uncommon uveitis with multiple inflammatory chorioretinal lesions. Using multimodal imaging technique, physicians can better differentiate these lesions for diagnosis and for further monitoring. Our results demonstrated that these chorioretinal lesions in MCP may display neovascular activities that might not be seen easily using conventional FA or ICGA study. With OCT-A, ophthalmologists could identify and monitor subtle choroidal neovascularization (CNV) changes over these punched-out lesions.

Purpose: We describe with multimodal imaging the presentation and follow-up for a patient with idiopathic multifocal choroiditis and a transient peripapillary white ring., Methods: Case report., Results: A 39-year-old Asian woman was initially seen for an evaluation of lattice degeneration in 2015. Her medical history included Graves disease and psoriasis. Best-corrected visual acuity was 20/25 in her right eye and 20/25 in her left eye. Ultra-widefield fundus autofluorescence imaging showed a curvilinear hyperautofluorescent line in her right eye. One year later, the patient returned complaining of floaters in her right eye for 1 month. Her visual acuity was unchanged. Funduscopic examination showed new inflammatory yellowish lesions in the right eye corresponding to hyperreflective sub-retinal pigment epithelium lesions on structural spectral domain optical coherence tomography. Fluorescein angiography showed corresponding late staining of these active lesions. Late-phase indocyanine green angiography showed multiple nummular hypocyanescent dots. Ultra-widefield fundus autofluorescence showed large areas of hyperautofluorescence. The patient was started on a 60-mg oral prednisone taper and demonstrated subsequent regression of the inflammatory lesions. Ten months later, the patient returned emergently with complaints of floaters in both eyes for 2 days and a new temporal scotoma in her left eye. Funduscopic examination demonstrated a white ring around the optic nerve of the left eye corresponding to a hyperautofluorescent lesion. Ultra-widefield fundus autofluorescence showed new areas of hyperautofluorescence in both eyes. Structural spectral domain optical coherence tomography showed new sub-retinal pigment epithelium inflammatory lesions and a disruption of the ellipsoid zone in both eyes. The patient was again treated with a 60-mg oral prednisone taper and demonstrated subsequent restoration of the ellipsoid zone., Conclusion: To our knowledge, this is the first report of a transient annular white ring occurring in a case of multifocal choroiditis. There was marked restoration of the disrupted ellipsoid zone after treatment with oral corticosteroids.

Purpose: To report a case of serpiginous choroiditis imaged with optical coherence tomography angiography (OCT-A)., Methods: Case report., Results: Multimodal imaging and OCT-A were performed to investigate serpiginous choroiditis in a 65-year-old patient. Comparison between OCT-A images and intermediate and late phase indocyanine green angiography revealed that the hypofluorescent areas on indocyanine green angiography corresponded topographically to the dark areas seen in the choriocapillaris layer of OCT-A., Conclusion: The OCT-A was shown to be able to detect vascular nonperfusion at the level of the choriocapillaris and could be helpful, especially for follow-up purposes, in clinical practice for choriocapillaritis such as serpiginous choroiditis.

Serpiginous choroiditis represents an inflammation, often asymmetric, situated at the level of the inner choroid, which is related to the retinal pigment epithelium and the choriocapillaris. It is known as a primarily idiopathic, but there are authors who consider it an autoimmune process. Many times, fundus autofluorescence is the investigation which is guiding the diagnosis, the management, also the follow-up together with the determination of the progressive visual prognosis. Local treatment is proven to be sometimes an adjunctive treatment often effective. Abbreviations: SC = Serpiginous choroiditis; RPE = Retinal pigment epithelium.

An immunocompromised patient had positive blood cultures for Mycobacterium intracellulare and no identifiable organ seeding was started on treatment. One month later, the patient was clinically well with negative blood cultures but drug-induced myelotoxicity had developed. Ocular fundus examination at this time revealed bilateral choroidal granulomas which changed patient management.

Objective: To investigate optical coherence tomography (OCT) characteristics of tuberculous serpiginous-like choroiditis (Tb-SLC) and serpiginous choroiditis (SC) and to perform OCT to differentiate between these conditions., Methods: This retrospective, case-control study examined consecutively enrolled patients with active Tb-SLC or SC. Patients underwent comprehensive ocular examinations and imaging (OCT, color fundus photography, autofluorescence imaging, fluorescein angiography, and indocyanine green angiography). Findings were examined and compared between eyes with SC and Tb-SLC., Results: Nine patients with active Tb-SLC (14 eyes) and 8 with active SC (12 eyes) were included. The following OCT findings were observed significantly more often in the Tb-SLC group than in the SC group: vitreal hyper-reflective spots [5 Tb-SLC eyes (36%), no SC eyes; P = 0.02], intraretinal edema [11 Tb-SLC eyes (79%), 3 SC eyes (25%); P = 0.01], sub-retinal pigment epithelium (RPE) drusenoid deposits [11 Tb-SLC eyes (79%), 2 SC eyes (17%); P < 0.01], and choroidal granulomas [8 Tb-SLC eyes (57%), 2 SC eyes (17%); P = 0.03]. A hyporeflective, wedge-shaped band was observed more often in the SC group [5 Tb-SLC eyes (36%), 9 SC eyes (75%); P = 0.045] than in the Tb-SLC group. The incidence of other OCT signs did not differ between the groups and included outer nuclear layer hyper-reflection, outer retinal tabulation, and choriocapillaris point-like hyper-reflection., Conclusion: Vitreal hyper-reflective spots, intraretinal fluid, sub-RPE drusenoid deposits, and choroidal granulomas on OCT images may indicate Tb-SLC. Additionally, a hyporeflective, wedge-shaped band may indicate SC. Therefore, OCT is likely helpful in differentiating between Tb-SLC and SC., (Copyright © 2018 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.)

Background/purpose: Quantitative methods for posterior uveitis are necessary for precise appraisal and follow-up of inflammation in practice and in clinical trials. The aim of this study was to assess fluorescein angiography (FA), indocanine green angiography (ICGA), and enhanced depth imaging optical coherence tomography choroidal thickness (EDI-OCT CT) in two stromal choroiditis entities, birdshot retinochoroiditis (BRC), and Vogt-Koyanagi-Harada disease (VKH), as well as to determine (1) disease patterns, (2) respective response to therapy, and (3) their potential utility in clinical trials in comparison to vitreous haze, the present standard outcome used in clinical trials., Methods: This retrospective study included newly diagnosed patients with BRC and VKH, seen at the Centre for Ophthalmic Specialized Care, Lausanne, Switzerland. Angiographic signs were quantified using an established dual FA/ICGA scoring system for uveitis at presentation and on follow-up. FA/ICGA score ratios were compared between diseases to determine disease patterns. EDI-OCT CT was determined using a spectral domain instrument. Vitreous haze was determined using the SUN (Standardization of Uveitis Nomenclature) method., Results: Among 1872 uveitis patients seen from 1995 to 2016, 8 newly diagnosed BRC patients (16 eyes) and 6 newly diagnosed VKH patients (12 eyes) had sufficient data for study inclusion. Patients with BRC and VKH at initial onset had mean FA scores of 16.1 ± 7.0 vs. 4.6 ± 2.1 (p < 0.0001), respectively, while mean ICGA scores were similarly high in the two diseases, 18.9 ± 3.6 (BRC) vs. 20.8 ± 7.5 (VKH). After therapy, FA and ICGA scores decreased significantly for both entities (- 60% of FA score and 55% of ICGA score in BRC vs. - 72% of FA score and - 87% for ICGA score in VKH). EDI-OCT CT decreased significantly in the two entities. Vitreous haze was almost absent in VKH and low in BRC., Conclusion: Dual FA/ICGA scoring showed the diverse disease patterns of BRC and VKH; both the retina and choroid were involved at onset in BRC, whereas VKH was a pure choroidal disease with later spillover into the retina. Dual FA/ICGA allowed for the precise measurement of inflammation at onset and upon follow-up. EDI-OCT CT responded to therapy in both diseases but was found to be of limited use in this early/subacute disease phase because it lacked sensitivity to detect subclinical recurrences and was therefore only useful for long-term follow-up. Vitreous haze was low in both entities and thus useless as an inflammatory parameter., Competing Interests: The authors declare no personal or economic conflict of interest., (Georg Thieme Verlag KG Stuttgart · New York.)

Background and Objective: Punctate inner choroidopathy (PIC) is an inflammatory chorioretinopathy characterized by multiple punctate, hypopigmented fundus lesions. Optical coherence tomography angiography (OCTA) is an emerging imaging modality that enables high-resolution visualization of the retinal and choroidal vasculature. The objective of this study is to examine the OCTA findings in PIC., Patients and Methods: Observational, retrospective review of five patients with PIC., Results: OCTA revealed several features in PIC lesions: distinctly visible choroidal neovascular membranes when present, as well as flow voids within the choroid and choriocapillaris layers that correspond with hypocyanescent lesions on indocyanine green angiography., Conclusion: OCTA may serve as a useful adjunctive imaging modality in diagnosing and monitoring patients with PIC. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:786-792.]., (Copyright 2017, SLACK Incorporated.)

Purpose: To analyze and describe the imaging characteristics of tubercular serpiginous-like choroiditis using optical coherence tomography angiography (OCTA) and to compare these findings with multimodal imaging., Methods: In this prospective cross-sectional study, multimodal imaging was performed in subjects with tubercular serpiginous-like choroiditis using OCTA (Optovue RTVue XR Avanti), enhanced-depth imaging OCT (Heidelberg Spectralis), fundus autofluorescence, fluorescein angiography, and indocyanine green angiography. Distinct morphologic features of the retinochoroidal vasculature at the sites of choroiditis lesions were analyzed on OCTA imaging. Multimodal imaging analysis was performed to study the changes observed on OCTA., Results: Eighteen eyes (18 subjects, 16 males) were included in the study. The en face OCTA images demonstrated discrete areas of flow void beneath the retinal pigment epithelium-Bruch membrane layer suggestive of choriocapillaris hypoperfusion that corresponded well with indocyanine green angiography, especially in the chronic phase. Additional information such as areas of preserved choriocapillaris, vascular tufts, and tangled vessels were observed using OCTA among lesions in advanced stages of healing. Compared with indocyanine green angiography, the areas of choriocapillaris atrophy appeared better defined on OCTA and correlated well with enhanced-depth imaging OCT., Conclusion: The OCTA images provide high-resolution structural information of the retinochoroidal vasculature in tubercular serpiginous-like choroiditis. Morphologic information obtained from OCTA images correlates well with and supplements other imaging techniques such as indocyanine green angiography and enhanced-depth imaging OCT.

Background and Objective: New imaging methods provide novel insights into the pathogenesis of acute posterior multifocal placoid pigment epitheliopathy (APMPPE)., Patients and Methods: Four patients (eight eyes) in acute, subacute, and late phases of the disease were analyzed with multi-modal imaging methods including optical coherence tomography angiography (OCTA), structural OCT, fundus photography, and fundus autofluorescence. One patient was observed during the entire disease course., Results: In acute and subacute phases of the disease, an early blockage in fluorescein angiography was found. OCTA showed perfusion defects in choriocapillaris and choroid slabs. During the course of disease, perfusion deficits observed in OCTA imaging resolved first in the choroid and then in the choriocapillaris slab., Conclusion: Multi-modal imaging including OCTA supports the thesis that the underlying pathology of APMPPE is an inflammatory impairment of the choroidal circulation with secondary damage to the outer retina. OCTA might be able to replace fluorescein and indocyanine angiography in the diagnostic work-up of APMPPE. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:727-733.]., (Copyright 2017, SLACK Incorporated.)

Purpose: To describe the findings seen on optical coherence tomography angiography (OCTA) in patients with punctate inner choroidopathy (PIC) and multifocal choroiditis and panuveitis (MCP) complicated by choroidal neovascular membranes., Methods: This was an Institutional Review Board-approved prospective, descriptive case series. 12 patients with PIC and MCP complicated by choroidal neovascularisation (CNV) were included. Each patient underwent slit-lamp examination by a uveitis specialist followed by conventional spectral domain OCT imaging of the macula. OCTA images of the macula were then obtained., Results: 12 patients were enrolled in the study, out of which 9 patients were followed longitudinally. CNV was identified in 11 of the 12 patients. In all patients where fluorescein angiography (FA) was inconclusive for presence of CNV, OCTA identified CNV. Various lesions on OCT suggestive of activity correlated with changes in the vascular structure of OCTA to confirm suspicion of clinical activity., Conclusion: In patients with PIC and MCP complicated by CNV, OCTA successfully identified underlying CNV. Given the difficulty of differentiating inflammatory lesions from early CNV on OCT and FA, OCTA may provide a valuable method of monitoring patients with posterior uveitis highly correlated with development of CNV., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Purpose: To report multimodal imaging in patients with serpiginous choroiditis., Methods: A 60-year-old woman with active serpiginous choroiditis in the right eye was evaluated during the disease course with multimodal imaging, which included fluorescein angiography, swept-source optical coherence tomography (SS-OCT), OCT angiography, fundus autofluorescence (FAF), and retromode imaging., Results: The patient had subretinal, yellowish lesion on the macula at presentation. The margin of the lesion was remarkable in FAF and retromode imaging. SS-OCT scans revealed slightly thickened hyporeflective space and tiny hyperreflective spots at the choriocapillaris level. OCT angiography demonstrated decreased vascularity on the choriocapillaris. Although the area was partially replaced with irregular capillaris, the photoreceptor defect persisted following systemic corticosteroid therapy., Conclusions: Multimodal imaging shows that inflammation of the choriocapillaris is a main pathology of serpiginous choroiditis. The destruction of the choriocapillaris may lead to the photoreceptor disruption, resulting in permanent visual loss in serpiginous choroiditis.

Purpose: To describe multimodal imaging findings of an evolving case of acute posterior multifocal placoid pigment epitheliopathy occurring in a young healthy male., Methods: Case report of a patient with acute posterior multifocal placoid pigment epitheliopathy including comprehensive systemic and ocular examinations. Ultra-widefield autofluorescence, fluorescein angiography, indocyanine green angiography, and serial optical coherence tomography angiography were performed., Results: A 34-year-old male presented with acute vision loss in his left eye for 2 weeks. His best-corrected visual acuity was 20/20 in his right eye and 20/200 in his left eye. Dilated funduscopic examination revealed multiple creamy white deep retinal lesions showing macular involvement of the left eye with a diffuse area of pigmentary changes. The presence of multiple areas of hypoperfusion of the inner choroid were demonstrated with fluorescein and indocyanine green angiography. Serial optical coherence tomography angiography showed multiple evolving areas of decreased flow at the level of the inner choroid., Conclusion: Although the pathogenesis of acute posterior multifocal placoid pigment epitheliopathy remains unknown, there is growing evidence of a primary choroidal involvement with secondary damage to the overlying retinal pigment epithelium and the outer retinal layers. Optical coherence tomography angiography may provide valuable information for the diagnosis and follow-up of this condition avoiding invasive angiographic procedures.

This article reports the case of a 32-year-old female patient who presented with severe spasmodically occurring retrobulbar pain, headaches and light sensitivity. The neurological examination confirmed cephalalgia but no evidence of other neurological symptoms was found. Ophthalmoscopy revealed yellowish patchy lightened spots in the middle periphery. Fluorescein angiography (FLA) and indocyanine green angiography (ICGA) revealed findings typical for acute posterior multifocal placoid pigment epitheliopathy (APMPPE). Hypofluorescent areas visible using ICGA in the early and late phases showed corresponding hypoperfused areas by optical coherence tomography angiography (OCT-A). To the best of our knowledge this is the first description of these findings in OCT-A.

Purpose: To describe optical coherence tomography angiography (OCTA) features of lesions of tubercular multifocal serpiginoid choroiditis (TB MSC) that developed paradoxical worsening (PW)., Methods: In this prospective study, subjects with TB MSC who developed PW upon initiation of anti-tubercular therapy were included. Multimodal imaging was performed using OCTA, enhanced-depth imaging OCT, fluorescein angiography (FA), and indocyanine green angiography (ICGA). Morphologic changes in the retinochoroidal vasculature during progression of TB MSC were assessed on OCTA., Results: Five subjects (4 males, 1 female) were included in the study. PW of the lesions was associated with increased areas of choriocapillaris flow void on en face OCTA in all eyes. The lesions showed partial healing in the center and continuous progression at the active edges. Two eyes showed development of vascular tufts on OCTA as the lesions progressed., Conclusions: OCTA provides high-resolution imaging of progressive choriocapillaris hypoperfusion among TB MSC patients developing PW of the disease.

Purpose: To assess the utility of ultra-wide field (UWF) versus conventional fundus imaging in the management of tubercular (TB) posterior uveitis., Methods: Twenty-two consecutive patients (33 eyes) diagnosed with TB posterior uveitis in a tertiary care center who underwent UWF fundus photography and fluorescein angiography (FA) between July 2014 and March 2015 were included. Complete clinical and imaging records of the patients were retrospectively reviewed. A circle simulating the central 75-degree field was drawn on UWF pseudocolor and fluorescein angiography images. Findings within the circle were compared with the information yielded by the complete image and its impact on patient management was noted., Results: The clinical manifestations of posterior tubercular uveitis included retinal vasculitis (17 eyes), multifocal serpiginoid choroiditis (13 eyes), choroidal granulomas (2 eyes) and intermediate uveitis (1 eye). UWF imaging revealed additional capillary non-perfusion areas, neovascularization, active vasculitis, and peripheral choroiditis lesions in 30/33 eyes (90.9%), which influenced treatment decision in 15 eyes (45.5%)., Conclusions: UWF imaging is useful in the detection of peripheral pathologies in tubercular posterior uveitis that may influence management decisions, such as addition of immunosuppressive therapy or scatter laser photocoagulation.

Choroidal neovascularization secondary to tuberculous serpiginous-like choroiditis (Tb-SLC) is uncommon and requires further invasive imaging, such as fluorescein and indocyanine green angiography. We evaluate the optical coherence tomography angiography (OCTA) findings in a patient with a Tb-SLC and present the use of this investigation as a non-invasive diagnostic and follow-up clinical tool in this disease.

Multifocal serpiginoid choroiditis is an infectious variety of serpiginous choroiditis. The disease is characterized by infectious etiology and overlapping clinical features in an intermediary form of acute posterior multifocal placoid pigment epitheliopathy and serpiginous choroiditis. In a 33-year-old patient, bilateral multiple placoid partially confluent chorioretinal lesions were diagnosed after a febrile flu-like episode. On the right eye, there was a progressive decrease in visual acuity. Later, the lesions had a prolonged progressive devastating clinical course and widespread distribution of placoid lesions, and took the form of serpiginoid choroiditis. We conducted extensive laboratory work-up and ancillary investigation for granulomatous diseases such as tuberculosis and sarcoidosis, and the results were not consistent with these entities. Systemic medical work-up revealed a history of exposure to the human immunodeficiency virus, herpes simplex virus 1, varicella zoster virus and cytomegalovirus. The titer of Mycoplasma pneumoniae IgM antibodies was positive. After serological analysis positive for Mycoplasma pneumoniae, systemic antibiotic therapy and anti-inflammatory doses of corticosteroids were administered. Improvement of visual acuity after the introduction of causal antibiotic therapy in combination with anti-inflammatory therapy confirmed our suspicion that Mycoplasma pneumoniae was the etiologic cause of multifocal serpiginoid choroiditis.

Purpose: To describe solitary idiopathic choroiditis in the setting of extensive animal exposure., Methods: A 56-year-old asymptomatic female equestrian with an extensive history of exposure to horses and dogs and a trapper of wild animals and rodents was discovered to have an amelanotic choroidal mass in the macular region and referred for suspicious atypical nevus., Results: Funduscopy revealed a deep yellow mass with overlying retinal pigment epithelial thinning and without visible subretinal fluid or lipofuscin. Mild hyperautofluorescence represented unmasking of scleral autofluorescence. Ultrasonography showed a 1.8-mm-thick echodense lesion. Enhanced depth imaging-optical coherence tomography disclosed a dense, elevated scleral mass with "volcanic" configuration, demonstrating choroidal compression and trace overlying subretinal fluid. These features were consistent with solitary idiopathic choroiditis/scleritis. Systemic evaluation for standard cat-related bartonellosis, tuberculosis, sarcoidosis, and syphilis were negative. Horse-, dog-, and rodent-related bartonellosis testing was not available. Observation was advised, and the findings remained stable at 6 months., Conclusion: Solitary idiopathic choroiditis is best imaged on enhanced depth imaging-optical coherence tomography as a scleral lesion with "volcanic" configuration and often secondary to previous Bartonella infection. Serologic positivity for cat-related Bartonella decays over time, and testing for horse-, dog-, or rodent-related Bartonella is not commonly used.

Purpose: To describe optical coherence tomography angiography (OCTA) findings in multifocal choroiditis (MFC) with active lesions and to characterize the concordance between the OCTA and other traditional imaging modalities., Design: Reliability and validity analysis., Methods: Patients with suspected choroidal neovascularization (CNV) or acute inflammatory lesions associated with MFC were assessed in this study. All participants underwent preliminary traditional multimodal imaging including color fundus photography, fundus autofluorescence, near-infrared reflectance imaging, spectral-domain optical coherence tomography, and fluorescence angiography (FA). The participants were prospectively recruited to perform OCTA. OCTA findings of active lesions were compared with other traditional imaging results. Vascular flow signal representing CNV was identified, and a quantitative analysis of CNV size was performed on OCTA., Results: Fifty-two eyes of 26 MFC patients (14 were bilaterally affected and 12 were unilaterally affected) were included. Among the 23 active CNV cases, 20 were confirmed on OCTA while the other 3 were invalid owing to severe motion artifacts. OCTA of CNV showed a well-circumscribed vascular network (mean flow area, 0.271 mm(2) [± 0.144 mm(2)]). Among the 34 inflammatory lesions in 13 eyes, 32 showed no blood flow in the outer retina on OCTA while the other 2 showed blood flow signal., Conclusions: OCTA has a predominant advantage in differentiating CNV from inflammatory lesions. It also allows the visualization of detailed vascular structure of CNV and the function of flow area measurement realizes the quantitative analysis of CNV. Hence, it could be an alternative option for CNV identification and may better guide treatment., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Case Report: A 20 year-old healthy patient consulted due to acute loss vision in his left eye. A fundus examination showed a macular alteration compatible with unifocal helioid choroiditis, characterized by being an atypical inflammatory yellow-white, round, single lesion of approximately an optic disc in diameter. The etiology study detected low Antitoxoplasma gondii Ig G (immunoglobulin) titers., Discussion: The non-specificity of the serology and the atypical characteristics of the lesion is a limitation in the diagnosis. The Goldmann-Witmer coefficient may be useful in the diagnosis of atypical lesions, by comparing the concentration of IgG from the serum and aqueous humor., (Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.)

A single case of multifocal choroiditis with panuveitis (MFCPU) was investigated by a three-dimensional (3-D) high-penetration optical coherence tomography. The HP-OCT is based on a swept-source OCT technology, uses a probe beam with a center wavelength of 1060 nm, and possesses a depth resolution of 10.4 micromin tissue. Two eyes of an MFCPU patient were involved in this study. The eyes were also examined by color fundus photograph, fluorescein angiography (FA), and indocyanine green angiography (ICGA). Findings in these four modalities are comparatively discussed. The OCT scans revealed the following characteristic properties of the lesion sites. Thinning of the retina, destructuring of the retinal layers, and disappearance of the junction of the inner and outer segments of the photoreceptor (IS/OS). Due to the high penetration of this OCT system, the following characteristic properties of the lesions were also observed: localized thinning of the choroid, occlusion of the choroidal vessels, and localized hyper-reflectivity that may represent hyper-pigmentation of the choroid.

Background: Long-term follow-up and angiographic findings of serpiginous choroiditis, a chronic disease with recurrences of unknown origin, are reported., Patients and Methods: A retrospective analysis of the data of 4 patients with serpiginous choroidopathy, who were treated in the eye clinic of Mainz in the past 10-18 years was made. Progression of disease was documented by photography, as well as fluorescein and indocyanine green angiography. Patients with acute lesions were treated with steroids per os for some weeks., Results: All 8 eyes developed 2-7 recurrences with progression of the chorioretinal scars. In cases of macular involvement the functional results were worse. No choroidal neovascularizations were seen. During follow-up 3/8 eyes became blind, 4/8 eyes retained reading vision. Indocyanine green angiography usually demonstrated many more lesions than those seen with fluorescein. In 3 cases acute choroidal lesions were detected only with indocyanine green angiography whereas no sign of inflammation was demonstrated by fluorescein angiography., Conclusion: The functional prognosis of serpiginous choroiditis is bad because all eyes developed at least 2 recurrences during follow-up. Use of indocyanine green angiography may help to better describe the full extent of the disease, even before it is seen with fluorescein angiography. It can help the observer to determine the precise clinical progression of the disease.

Purpose: To evaluate the clinical evolution and treatment of serpiginous choroiditis in 11 diagnosed patients., Methods: Retrospective study of 11 cases diagnosed with serpiginous choroiditis in our area, from 1980 to the present. We analyzed age at onset of symptoms, systemic diseases, ophthalmological symptoms at presentation, the location of lesions, initial and final visual acuity, recurrences, treatment régime and development of subretinal neovascularization. A complete ophthalmological examination and fluorescein angiograms were performed in all of them., Results: The mean period of follow-up was 4 years. Average age was 56 years, predominantly in men (10/1). Five patients had known ischemic cardiopathy and systemic hypertension, one patient underwent a kidney transplant. All of them were treated with oral prednisone (1-1.5 mg/kg/daily) in the active stages. Three patients received triple therapy (prednisone, cyclosporine and azathioprine) that did not prevent the recurrences. Five patients developed a subretinal neovascularization, bilateral in three of them., Conclusions: The serpiginous choroiditis is a rare entity and the visual outcome prognosis is determined by the macular involvement. Men are predominantly affected in our series and corticosteroid treatment is effective in acute inflammatory episodes. Recurrences could not be prevented by triple therapy with immunosuppressive agents in our three patients.

Case Report: A healthy 57 year-old woman with past untreated pulmonary tuberculosis, disclosed a bilateral uveitic syndrome characte rized by iritis, vitreitis, multiple peripheral retinal punched-out lesions, and cystoid macular edema. Systemic evaluation was unremarkable except for a 30 mm tuberculin skin test. Relapses occurred after oral and periocular corticosteroids were interrupted, but the inflammation completely disappeared after a 6 month course of isoniazid, rifampicin and pyrazinamide., Discussion: Intraocular tuberculosis should be considered as a treatable cause of peripheral multifocal choroiditis, after ruling out other etiologies.

Purpose: To report a variant form of serpiginous choroiditis, that initially or predominantly involved the macular area., Methods: Nine eyes of 6 patients with the macular form of serpiginous choroiditis were evaluated clinically and angiographically in a longitudinal fashion for a period of 12-36 months. The active stage and the recurrences were treated by oral and periocular cortico steroids; and two patients were supplemented with oral azathioprine. Most of these patients were referred to our center with varied diagnoses., Results: In this group, 4 were male and 2 were female with an average age of 30.5 years. Three patients had bilateral macular lesions, two had typical serpiginous choroiditis in the fellow eye and the remaining one had unilateral macular involvement alone. The initial visual acuity was 6/60 or less in 60% eyes whereas the final visual acuity was 6/18 or better in 66% eyes. Angiographic findings were typical of serpiginous choroiditis characterised by early hypofluorescence followed by leakage and staining of the borders and the lesion itself without any evidence of choroidal ischaemia or retinal vascular abnormalities., Conclusion: The macular variant of serpiginous choroiditis can mimic many other macular pathologic lesions, thus posing a diagnostic dilemma. Because of its relentless destructive course, early diagnosis and prompt treatment is required to prevent sight-threatening complications.

Case Report: The case of a 63 year old woman presenting fibrous subretinal lesions in the posterior pole on a routine ocular fundus check up is reported. The angiographic study showed a choroidal origin window defect next to hypofluorescence areas. The patient did not complain of vision loss or scotomas at any time., Discussion: This clinical picture could be classified as a progressive subretinal fibrosis syndrome with atypical features. However, a differential diagnosis with other choroidal inflammatory conditions should be carried out even though many authors may consider them as different developmental phases of the same entity.

A histoplasmin skin test was performed on 56 patients with focal hemorrhagic choroiditis. The test was negative in 53 choroiditis patients and positive in three patients. The three patients with posi-ive skin test had been living for a long time in the eastern part of the U.S.A. where histoplasma capsulatum occurs endemically. The results of this study suggest that the infection with histoplasmin capsulatum is not the cause of focal hemorrhagic choroiditis in our area.