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Milan Shah, David J. Jacobs, Audina M. Berrocal; Spectral Domain OCT Findings in Diffuse Acute Unilateral Neuroretinitis (DUSN) with Subretinal Neovascularization. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2172.
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To report three photodocumented cases of subretinal neovascularization in diffuse unilateral subacute neuroretinitis (DUSN). To further characterize these cases of subretinal neovascularization in DUSN by analysis of serial spectral-domain optical coherence tomography (SD-OCT) images and fundus photography.
A retrospective observational case series. Three patients were followed with fundus photography and serial Spectralis OCT (Heidelberg Engineering, GmbH, Heidelberg, Germany). A retrospective chart review was performed in addition to analysis of the serial images by which trends and correlations were established.
The development of subretinal fibrosis subsequent to neovascularization in DUSN was followed with serial SD-OCT and fundus photography in three eyes of three patients. Although there were multiple disseminated lesions throughout the fundi, subretinal neovascularization only developed within the fovea. The formation of subretinal neovascularization appeared to be preceded by progressive retinal pigment epithelium (RPE) atrophy. The fundi in these cases of DUSN were characterized by (1) atrophic neurosensory retina (2) retinal nerve fiber layer atrophy, (3) relatively preserved choroidal thickness and (4) subretinal fibrosis suggestive of a type 2 choroidal neovascular membrane (CNV).
Subretinal neovascularization in DUSN is a rarely reported entity. It is likely to be preceded by progressive atrophy of the pigment epithelium and appears to occur in the subfoveal location. Although the retina and RPE were found to be atrophic, the choroid appears to be preserved. Furthermore, the SD-OCT images suggest that a type 2 CNV process may be involved as is seen in other inflammatory diseases such as multifocal choroiditis and ocular histoplasmosis. Once a subretinal scar forms, there appears to be no further neovascular or exudative activity as suggested by serial follow-up.
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