Volume 26, Number 12—December 2020
CME ACTIVITY - Research
Clinical and Multimodal Imaging Findings and Risk Factors for Ocular Involvement in a Presumed Waterborne Toxoplasmosis Outbreak, Brazil1
Table 2
Type of lesion, fundus imaging modality |
Patterns of retinochoroiditis |
||
---|---|---|---|
Active phase, before treatment |
Cicatricial phase, after treatment |
||
Focal necrotizing retinochoroiditis | |||
Fundus photo or examination | Dense focal retinal whitening with indistinct borders, associated with overlying vitreous haze | Initially hypopigmented retinochoroidal scar, but frequently evolving with variable degree of pigmentation and subretinal fibrosis or preretinal gliosis | |
SD-OCT | Focal full-thickness hyper-reflectivity and disorganization of retinal layers indicating necrotizing retinitis; surrounding retinal thickening, signaling edema; numerous overlying hyper-reflective dots at the vitreous indicating vitreal inflammatory cell exudate; and underlying fusiform choroidal thickening, with loss of stromal/luminal pattern indicating reactive choroiditis | Disorganization of retinal architecture; hyper-reflectivity at the level of the scar, but without perilesional retinal thickening; resolution of choroidal thickening; marked decrease in the number of overlying vitreal hyper-reflective dots; and frequent tent-like focal detachment of the less thickened overlying posterior hyaloid | |
FAF reflectances | Subtle hypo- or hyper-autofluorescence changes at the level of the active lesion; near infrared reflectance can indicate active focus but not as remarkably as red-free reflectance | Increased autofluorescence signal in the first weeks, then hypo-autofluorescence at the level of the scar after several months; scars less clearly delineated by near-infrared than red-free reflectance, but both reveal retinal wrinkling in the presence of epiretinal membrane | |
FFA |
Early hypofluorescence, with progressive hyperfluorescence and late leakage at the retinochoroiditis lesion; reactive changes, including hyperfluorescence, of optic disc indicating edema; staining of venular walls, signaling periphlebitis |
Variable window defects and blockage at the level of the scar; staining in the presence of subretinal fibrosis and epiretinal gliosis |
|
Punctate retinochoroiditis | |||
Fundus photo or examination | Multiple subtle, indistinct, or confluent gray-whitish punctate retinal infiltrates with minimal vitreous haze | Very subtle changes in retinal reflex, sometimes with minor hypopigmentation, but frequently with no apparent abnormality | |
SD-OCT | Multifocal hyper-reflectivity at the inner retinal layers, demonstrating retinitis, occasionally extending to deeper layers, with surrounding retinal thickening (edema); numerous overlying hyper-reflective dots indicating vitreal inflammatory cell exudate, along with thickening and shallow detachment of the posterior hyaloid; mild choroidal thickening without apparent major change in reflectivity | Frequent normalization of the retinal architecture, sometimes with mild disruption of outer retinal layers or retinal pigment epithelium; normalization of choroidal thickening; marked decrease in the number of overlying vitreal hyper-reflective dots and frequent tent-like focal detachment of the less-thickened overlying posterior hyaloid | |
FAF reflectances | Subtle hypo- or hyper-autofluorescence changes at the level of the punctate active lesions; near-infrared reflectance can show changes at the area of active foci but not as remarkably as red-free reflectance | Autofluorescence and reflectance changes are minimal or absent | |
FFA | Progressive but mild hyperfluorescence or late leakage at the site of punctate lesions; reactive changes, including hyperfluorescence of optic disc, demonstrating edema; staining of venular walls indicating periphlebitis |
Normal or showing minimal punctate window defects | |
*FAF, fundus autofluorescence; FFA, fundus fluorescein angiography; SD-OCT, spectral-domain optical coherence tomography.
1Presented in part at the 2015 American Uveitis Society Fall meeting, November 15, 2014, Las Vegas, Nevada, USA
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Page updated: November 19, 2020
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