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Abstract
Purpose
To report the effectiveness of intravitreal bevacizumab treatment for serous retinal detachment associated with Leber's idiopathic stellate neuroretinitis.
Case summary
A 56-year-old male visited our clinic complaining of visual disturbance for three days in his right eye. His best corrected visual acuity was 0.5. Relative afferent pupillary defect and pain when moving eyes were noted in his right eye as well as inflammatory cells in the vitreous cavity. On funduscopic examination, disc swelling with hemorrhage and stellate-shaped hard exudates were noted at the perifovea. Ishihara color vision test showed anomalous trichromacy in his right eye. Hyperfluorescence around the disc was observed on fundus fluorescein angiography. Optical coherence tomography showed disc swelling with serous retinal detachment at the fovea. Inferior altitudinal scotoma was noted on visual field examination. The patient underwent intravitreal bevacizumab injection and topical steroid medication. After six days, the patient's symptoms and disc swelling improved, and decreased subretinal fluid was observed. After six weeks, his best corrected visual acuity was 1.0. Nine weeks later, visual field examination showed nonspecific scotoma.
References
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Figure 1.
Consecutive fundus color photographs of the patient. At the initial visit, disc swelling with blurring of the disc margin, disc hemorrhage, and stellate-shaped hard exudates at the perifovea are noted (A). Six days after the first injection of bevacizumab, improvement of disc swelling but slight increased exudates at the fovea was noted (B). Six weeks after injection of bevacizumab (C). Note the resolution of disc swelling and improvement of stellate-shaped hard exudates at the perifovea (C). Fifteen weeks after the first visit, disc swelling with hemorrhage is completely regressed, and hard exudates remaining at the perifovea are markedly decreased compared to the fundus color photograph taken at 6 days after the first injection of bevacizumab (D).
Figure 2.
Fundus fluorescein angiography at the initial visit. Early hyperfluorescence at the optic disc continues until the late phase. Fundus fluorescein angiography at the initial visit (A, B, C). Early hyperfluorescence at the optic disc (A) continues until the late phase (B, C).
Figure 3.
Consecutive optical coherence tomography (OCT) images of the patient. Serous retinal detachment at the fovea and around the disc with subretinal fluid is noted (A). Six days after injection of bevacizumab, improvement of serous retinal detachment with decreased amount of subretinal fluid is noted (B). Six weeks after injection of bevacizumab, note the complete resolution of subretinal fluid and disruption of inner segment/outer segment (IS/OS) junction line at the nasal perifovea (C). Fifteen weeks after the first visit, disrupted IS/OS junction line at the nasal perifovea shows more improvement compared to the OCT image taken at 6 weeks after injection of bevacizumab (D).
Figure 4.
Automated visual field at the initial visit (A) and after 9 weeks (B). Although the reliability of the examination at 9 weeks is lower inferior altitudinal scotoma had disappeared at 9 weeks, compared to the initial visual field. POS = positive; NEG = negative; ASB = apostilbs; RX = prescription; DS = diopter sphere; DC = diopter cylinder; X = axis; GHT = glaucoma hemifield test; VFI = visual field index; MD = mean deviation; PSD = pattern standard deviation.
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