OSLI Retina

October 2018

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802 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ C A S E R E P O R T ■ OCT Angiography of Bilateral, Indolent, Nonprogressive, Multifocal Choroidal Lesions Francesco Romano, MD; Alessandro Arrigo, MD; Emanuela Aragona, MD; Pier Pasquale Leone, MD; Francesco Bandello, MD, FEBO; Maurizio Battaglia Parodi, MD, FEBO ABSTRACT: Indolent, nonprogressive, multifocal, choroidal lesions represent a newly described, benign, nosological entity that is diagnosed after exclusion of funduscopically similar uveitic and neoplastic processes. Although believed to be a unilateral condition, the authors describe the case of a 63-year-old man presenting with bilateral le- sions during a 2-year follow-up conducted by means of optical coherence tomography angiogra- phy (OCTA). Surprisingly, OCTA revealed that the vascular rarefaction, albeit primarily affecting the choriocapillaris, also involved the overlying retinal plexuses. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:802-805.] INTRODUCTION Finding bilateral yellowish choroidal lesions on fundus examination generally leads most retina specialists to thoroughly investigate for underlying infectious, inflammatory, or neoplastic diseases. Syphilis, sarcoidosis, uveal tumors, white dot syn- dromes, and Birdshot chorioretinopathy indeed represent the main differential diagnoses to take into consideration in this scenario. 1-3 On the oth- er hand, similar lesions of unclear etiology might exhibit a nonprogressive clinical course when pre- senting unilaterally and have been recently classi- fied as indolent nonprogressive multifocal choroi- dal lesions. 4 Herein, we describe a case of such condition with bilateral eye involvement studied by means of multimodal imaging, including ultra-widefield color fundus photography (California; Optos, Dun- fermline, United Kingdom), fundus fluorescein angiography and indocyanine green angiography (ICGA) (Spectralis HRA; Heidelberg Engineering, Heidelberg, Germany), and spectral-domain opti- cal coherence tomography (SD-OCT) and optical coherence tomography angiography (OCTA) (DRI Triton OCT; Topcon, Japan). CASE REPORT A 63-year-old white male was referred to our Retinal Heredodystrophy Unit (Department of Ophthalmology, Scientific Institute San Raffaele – Milan, Italy) in March 2015 with a diagnosis of bilateral peripheral chorioretinal dystrophy of un- known significance. Written informed consent was obtained for identifiable health information includ- ed in this case report. His past medical history was unremarkable, whereas his father disclosed the presence of wet age-related macular degeneration (AMD). The pa- tient did not complain of any visual disturbances or ocular symptoms, as his best-corrected visual acuity was 20/20 in both eyes. Slit-lamp biomicro- scopic examination of the anterior segment resulted normal, whereas dilated funduscopy revealed bi- lateral yellowish, flat, and irregular lesions appar- ently localized underneath the retina. The lesions were more copious in the right eye and in the na- sal periphery, without evident scars or pigmentary deposits. ICGA was performed to determine their From the Department of Ophthalmology, Ospedale San Raffaele, Vita- Salute University, Milan, Italy (FR, AA, EA, FBB, MBP); and Vita-Salute University, Ospedale San Raffaele, Milan, Italy (PPL). Originally submitted January 4, 2018. Revision received August 28, 2018. Accepted for publication September 9, 2018. Dr. Bandello has received personal fees from Allergan, Bayer, Boehringer Ingelheim, Hofmann La Roche, Novartis, NTC Pharma, Sifi, Sooft, Throm- bogenics, and Zeiss outside the submitted work. The remaining authors report no relevant financial disclosures. Address correspondence to Francesco Romano, MD, Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute University, Via Olgettina, 60 – 20132, Milan, Italy; email: f.romano@studenti.unisr.it. doi: 10.3928/23258160-20181002-09

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