A Case of Giant Nodular Posterior Scleritis

Hee Jun Kim; Min Sagong; Woo Hyok Chang

doi:10.3341/jkos.2011.52.10.1244

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Kim, Sagong, and Chang: A Case of Giant Nodular Posterior Scleritis

Original Article

J Korean Ophthalmol Soc 2011;52(10):1244-1248.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.10.1244

A Case of Giant Nodular Posterior Scleritis

Hee Jun Kim, MD, Min Sagong, MD, PhD, Woo Hyok Chang, MD

Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea

Address reprint requests to Woo Hyok Chang, MD Department of Ophthalmology, Yeungnam University Medical Center #317-1 Daemyeong 5-dong, Nam-gu, Daegu 705-717, Korea Tel: 82-53-620-3443, Fax: 82-53-626-5936, E-mail: changwh@ynu.ac.kr

Received 7 November 2010 Accepted 21 March 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The authors report a case of a giant subretinal nodular mass following surgical vitreous opacity removal.

Case summary

A 72-year-old man complained of visual loss and vitreous floaters in the left eye for 3 months (best corrected visual acuity: 0.1). The fundus was not clearly visualized due to vitreous opacity. Vitrectomy, phacoemulsification, and posterior chamber intraocular lens implantation were performed in the left eye. After removing the vitreous opacity, fundus examination revealed a creamy yellowish-white subretinal nodular mass (4 disc in size) inferotemporal to the fovea with adjoining chorioretinal folds and exudative retinal detachment. Fluorescein angiography (FA) of the left eye showed hypofluorescence of the nodule surrounded by a well-demarcated hyperfluorescent margin. B-scan ultrasonography revealed a prominent dome-shaped large echogenic nodule bordered by hypoechoic signal at the sclerochoroidal level. Giant nodular posterior scleritis was suspected and the patient was treated with oral corticosteroids. The large nodular lesion resolved completely within 3 months after initiation of the treatment and the best corrected visual acuity improved to 0.5.

Conclusions

The authors of the present case study recommend a thorough evaluation of large posterior segment nodular lesions in order to detect this under-recognized but eminently treatable condition.

Keywords: Nodular posterior scleritis, Subretinal nodular mass

References

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Figure 1.

Postoperative fundus photograph of the left eye showing a large subretinal nodular mass inferotemporal to the fovea with adjoining choroidal folds and exudative retinal detachment. (A) Central view. (B) Inferior view.

Figure 2.

Immediate post-operative fluorescein angiography (FA). (A) Early-stage FA of the left eye shows hypofluorescence corresponding to the nodule. (B) Late-stage FA shows hypofluorescence of the nodule surrounded by a well demarcated hyperfluorescent margin.

Figure 3.

(A) Before treatment, B-scan ultrasonography reveals a prominent dome-shaped hyperechoic nodule (asterisk) bordered posteriorly by hypoechoic signals (arrow) at the sclerochoroidal level. (B) 3 months later after treatment, B-scan ultrasonography shows regression of the hyperechoic nodular lesion.

Figure 4.

(A) Magnetic resonance imaging (T1-weighted, fat suppression, gadolinium-enhanced) shows a curvilinear nodular lesion along the posterior portion of the left eye. This lesion (arrow) reveals enhancement. (B) Magnetic resonance imaging (T2-weighted) shows hypointense signals (arrow).

Figure 5.

Fluorescein angiography (FA) taken at 3 months after treatment. (A) Early-stage FA of the left eye shows hypofluorescence with an indistinct border corresponding to the nodular lesion. (B) Late-stage FA shows poorly defined hyperfluorescent peripapillary area with hyperfluorescent spots at the macula and mottled hyperfluorescence in the area of the regressed nodular lesion.

Figure 6.

(A) After 48 hours of oral Prednisolone administration, the nodule has become smaller. (B) Three months later, the nodular lesion has resolved completely with visual improvement to 0.5 but epiretinal membrane and macular folding was still persistent.

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