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IDIOPATHIC MULTIFOCAL CHOROIDITIS WITH PERIPAPILLARY ZONAL INFLAMMATION: A MULTIMODAL IMAGING ANALYSIS

Jung, Jesse J. MD*,†,‡,§; Mrejen, Sarah MD†,‡; Freund, K. Bailey MD*,†,‡,§; Yannuzzi, Lawrence A. MD*,†,‡,§

RETINAL Cases & Brief Reports: Spring 2014 - Volume 8 - Issue 2 - p 141–144
doi: 10.1097/ICB.0000000000000026
Case Report

Purpose: To report a case of idiopathic multifocal choroiditis with transient peripapillary zonal inflammation that was followed with multimodal imaging and explain the mechanism by which chorioretinal atrophy may occur.

Methods: Observational case report. Review of the clinical examination, ocular imaging, and progression of idiopathic multifocal choroiditis.

Results: A 30-year-old white myopic man presented with complaints of worsening vision and a loss of visual field for 1 month in his left eye. Using multimodal imaging, including wide-field imaging with fluorescein angiography, fundus autofluorescence, and high-definition spectral-domain optical coherence tomography, he was found to have a macula involving peripapillary zonal inflammation consistent with acute idiopathic multifocal choroiditis involving the outer photoreceptor layer, ellipsoid layer, retinal pigment epithelium, and choroid. This area of inflammation was monitored with multimodal imaging over 7 months and slowly improved along with the patient's vision. Imaging allowed us to view the development of chorioretinal scars from several, but not all, acute inflammatory white spots.

Conclusion: Multifocal choroiditis is an inflammatory disorder affecting the outer photoreceptors, ellipsoid layer, retinal pigment epithelium, and choroid; and areas of acute inflammation may improve over time but can also leave permanent chorioretinal atrophy including focal lesions or peripapillary zonal atrophy.

Idiopathic multifocal choroiditis can present with a transient peripapillary zonal inflammation that may resolve with time. Acute inflammation can be monitored with multimodal imaging and demonstrate the mechanism of possible progression to chorioretinal atrophy.

*Department of Ophthalmology, New York University School of Medicine, New York, New York;

Vitreous Retina Macula Consultants of New York, New York, New York;

LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; and

§Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York.

Reprint requests: Lawrence A. Yannuzzi, MD, Vitreous Retina Macula Consultants of New York, Fifth Floor, 460 Park Avenue, New York, NY 10022; e-mail: layannuzzi@gmail.com

Supported by the LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Institute, and The Macula Foundation, Inc.

None of the authors have any conflicting interests to disclose.

© 2014 by Ophthalmic Communications Society, Inc.