Acute Idiopathic Maculopathy Complicated by Choroidal Neovascularization: New Insights Into Multimodal Retinal Imaging

Abstract

Purpose: To report a case of acute idiopathic maculopathy complicated by choroidal neovascularization (CNV) in which multimodal imaging was used to confirm the presence of CNV and follow the response to anti-vascular endothelial growth factor treatment.Methods: A 39-year-old man was referred to our clinic for the evaluation of maculopathy in the right eye. Multimodal imaging was performed including fundus photography, fundus autofluorescence, infrared fundus reflectance (IR), optical coherence tomography, fluorescein angiography, indocyanine green angiography, and optical coherence tomography angiography.Results: On the first examination, best-corrected visual acuity was 20/63 in the right eye and 20/20 in the left eye. A diagnosis of acute idiopathic maculopathy in the right eye was made on the basis of clinical presentation and multimodal imaging. After 3 months, bestcorrected visual acuity had decreased to 20/100. Fluorescein angiography and indocyanine green angiography suggested the presence of a CNV. Optical coherence tomography angiography confirmed the presence of the CNV and well outlined the extension of the neovascular network. The patient underwent 2 monthly bevacizumab intravitreal injections. One month after the second injection, best-corrected visual acuity improved to 20/25, and optical coherence tomography angiography showed regression of the neovascular network. Best-corrected visual acuity remained stable during 20 months of follow-up.Conclusion: Our case reports the uncommon association of acute idiopathic maculopathy complicated by CNV. Multiimaging approach allowed to document the features observed in this disease. Optical coherence tomography angiography was particularly useful in showing the extension of the neovascular network and response to treatment.

Case Report: Multimodal Imaging of Acute Idiopathic Maculopathy in a Chinese Woman

“…3,9,10 Visual prognosis is generally good except in those who develop complications such as choroidal neovascularization or subfoveal pigment degeneration. 1,7,10 Nearly half of patients suffer from flu-like symptoms such as fever, headache, and pharyngeal pain, which suggests a virus origin. 1,5,9,11 Approximately one in four patients is diagnosed with coxsackievirus infection based on hematologic testing or clinical findings such as hand, foot, and mouth disease or contact with children with hand, foot, and mouth disease.…”

“…Autofluorescence imaging visualizes the distribution of lipofuscin (a complex mixture of fluorophores that are by-products of the visual cycle), and near-infrared reflectance imaging visualizes subretinal structures such as the outer retina, the retinal pigment epithelium, and the choroid. 5,7,22,23 We compared the imaging of autofluorescence, near-infrared reflectance imaging, and OCT side by side, revealing that the hyperautofluorescent lesion was correlated with loss of the ellipsoid zone; the hyporeflective area on near-infrared reflectance imaging precisely coincided with the loss of the interdigitation zone on OCT, whereas the hyperreflective area was consistent with the thickened retinal pigment epithelium. Hence, we suggest near-infrared reflectance imaging as a good complement to autofluorescence in the observation of the retinal pigment epithelium in acute idiopathic maculopathy.…”

“…It typically affects young adults (mean age, 32 years; range, 14 to 59 years) with rapid onset and spontaneous recovery of vision 3,9,10 . Visual prognosis is generally good except in those who develop complications such as choroidal neovascularization or subfoveal pigment degeneration 1,7,10 . Nearly half of patients suffer from flu-like symptoms such as fever, headache, and pharyngeal pain, which suggests a virus origin 1,5,9,11 .…”

“…Less commonly HIV, flavivirus febricis infection, and H1N1 vaccination were reported to be associated as well 3–6 . The prognosis is generally good, with poor vision usually resulting from complications such as choroidal neovascularization or subfoveal pigment degeneration 1,7 . Here, we report multimodal imaging findings in a patient with acute idiopathic maculopathy.…”

“…[3][4][5][6] The prognosis is generally good, with poor vision usually resulting from complications such as choroidal neovascularization or subfoveal pigment degeneration. 1,7 Here, we report multimodal imaging findings in a patient with acute idiopathic maculopathy.…”