A 28-year-old female patient presented with metamorphopsia in her left eye starting 2 days earlier. There was nothing of note in her medical or family history, and her visual acuity was 1.0 in the right eye and 0.8 with -5.0 D refraction in the left eye. Anterior segment examination was normal. Fundus examination was normal in the right eye, but macular pigmentary alterations were observed in the left eye (). On FFA there was hyperfluorescence beginning in the early phases and increasing in the late phase, which was more suggestive of choroidal neovascular membrane (CNVM) than CSCR (). Although it is recommended for a definitive diagnosis, ICGA was not done. Despite smooth foveal contours in the left eye on OCT, an area of subfoveal focal choroidal excavation and overlying hyporeflective subretinal fluid were detected (). The lesion in the patient’s left eye was accepted as CNVM and an intravitreal bevacizumab injection was administered. At follow-up 1 month later, the patient’s symptoms had improved, vision in her left eye improved to 0.9 and the hyporeflective area evident on OCT had decreased in size. At 2-year follow-up, visual acuity in the left eye was 0.8 and persistent RPE changes were observed on fundoscopy (). Hyperfluorescence which increased slightly in the late phases was observed on FFA of the left eye (). On OCT, the focal choroidal excavation remained unchanged, the overlying hyporeflective area had resolved and the photoreceptor layer appeared continuous ().
A 55-year-old man (subject 1) presented with bilateral metamorphopsia, with decimal visual acuity being 0.8 in the right eye and 1.2 in the left. The clinical diagnosis of VKH was made based on bilateral panuveitis and multifocal exudative retinal detachments at the posterior poles (). High-dose corticosteroid therapy with gradual tapering was initiated 3 days after presentation. The serous detachments entirely resolved within 9 weeks and visual acuity in the right eye improved to 1.2.\nSerial spectral-domain OCT (SD-OCT) images obtained at the preuveitic, uveitic, and posttreatment phase are shown in . SD-OCT obtained 1 year before the onset of VKH due to symptoms of a floater and visual disturbance demonstrated a dome-shaped posterior protrusion of the RPE and outer retinal layers into the choroidal cavity (ie, conforming FCE) at the fovea in the right eye. SD-OCT at the uveitic phase identified multiple bilateral sensory retinal detachments, with the FCE now involving only the RPE (ie, nonconforming FCE). Nine weeks after the treatment, the nonconforming FCE returned into a conforming pattern.\nThe FCE pattern and its alteration during treatment of the case with VKH were compared to those of four subjects with FCE associated with other chorioretinal conditions (). This comparison group consisted of two patients with age-related macular degeneration (AMD; subjects 2 and 3), one subject with a macular hole (MH; subject 4), and one asymptomatic individual (subject 5). Treatment with intravitreal ranibizumab injections and vitrectomy had been performed in the patients with AMD and MH, respectively. A conforming FCE was observed in three patients (subjects 2, 3, and 5) and pattern alteration from nonconforming to conforming FCE was found after treatment in one subject (subject 4). In the two subjects with AMD, a hyperreflective material around the FCE was absorbed, resulting in a well-demarcated conforming FCE after treatment.