Choroiditis complicated by extensive subretinal fibrosis (SRF) is rare. Early detection of SRF is crucial because its irreversible nature definitively threatens visual prognosis.
Methods
A 64-year-old female patient, with unknown medical history, was referred for bilateral retinal fibrosing lesions. She had a visual acuity of 0.5/10 in the right eye for one year, and perceived only hand movements in the left eye for 12 years. Ophthalmological examination revealed bilateral posterior non-hypertensive, non-synechial, non-granulomatous uveitis, with 1+ vitritis and multiple white-yellow choroidal lesions associated with SRF.
Results
Multimodal imaging confirmed the diagnosis of ampiginous choroiditis associated with fibrosis and a significant choroidal neovascularization (CNV) in the right eye. Extensive testing revealed a tuberculous (TB) exposure and a positive Quantiferon test. A combination of antitubercular treatment, oral corticosteroids and monthly intravitreal anti-VEGF injections was initiated. One-month follow-up showed stable visual acuity in both eyes with a decrease in neovascular exudation.
SRF has been described in the literature as a sequela of chronic posterior inflammation. It develops in areas of intense choroidal inflammation, with a type 2 epithelial-mesenchymal transition mechanism of formation. CNV should always be sought, as both have similar anatomical locations and appearance. The extensive SRF in our patient is likely due to a significant treatment delay and lack of regular medical follow-up.
Conclusion
In cases of ampiginous choriditis, it is essential to investigate and treat TB. Untreated, it can lead to destructive scarring. Treatment must be initiated early to prevent lesion extension and the onset of these irreversible complications.
Conflict of interest
No
1
Last name
GLODEANU
Initials of first name(s)
CM
Department
Opthalmology
City
Paris
Country
France
2
Last name
TOUTEE
Initials of first name(s)
A
Department
Opthalmology
City
Paris
Country
France
3
Last name
DOMONT
Initials of first name(s)
F
Department
Internal Medicine
City
Paris
Country
France
4
Last name
BODAGHI
Initials of first name(s)
B
Department
Opthalmology
City
Paris
Country
France
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