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Kenji Matsushita, Rumi Kawashima, Takashi Fujikado, Kohji Nishida; Association between Functional and Morphologic Recovery in a Woman with Severe Outer Retinitis after Tonsillitis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4652.
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© ARVO (1962-2015); The Authors (2016-present)
To analyze the association between subjective functional parameters (SFPs) or objective functional parameters (OFPs) and morphologic parameters (MPs) during recovery of severe acute bilateral outer retinitis after tonsillitis.
A 27-year-old woman developed severe bilateral outer retinitis after acute tonsillitis. The first examination showed bilateral iridocyclitis and chorioretinitis and no systemic vasculitis, infection, or malignancy. Anti-recoverin antibody was not found. After tonsillitis resolution, she received steroid pulse therapy twice. After visual recovery, there was no recurrence and the SFPs were normal for 1 year. To analyze the recovery, we measured the visual acuity (VA) and perimetry for SFPs, full-field and multifocal electroretinography (ff-ERG/mf-ERG) amplitudes for OFPs, intensity of the microstructures photoreceptor layers on optical coherence tomography (OCT) and cone photoreceptor density in an adaptive optics imaging system (AO) for MPs.
OCT showed a blurred external limiting membrane and no interdigitation or ellipsoidal zone (IZ/EZ) at the first visit. The best-corrected VAs (BCVAs) were 0.15 and 0.09 in the right and left eyes, respectively. A central scotoma appeared and ff-ERG and mf-ERG amplitudes were non-recordable. The BCVA and central scotoma started to improve soon after treatment, followed by blurring of the EZ line on post-treatment day (PTD) 5. The EZ line was detected clearly on PTD 22; the cone and oscillatory potential responses of the ff-ERG began to recover followed by recovery of the rod response and mf-ERG foveal response amplitudes on PTD 36. The OFPs may depend on visualization of not only the EZ line and but also the IZ line. However, mf-ERG response remained low in the posterior pole around the macula where the EZ line was partially still fragmented. The cone densities in those areas were smaller with AO (18,937 cells/mm2 in 4° temporal retina and 53 cells/mm2 in 12° temporal retina).
Severe outer retinitis after tonsillitis responded to steroid pulse therapy and recovered completely subjectively. The recoveries of the MPs on OCT were associated with those of the SFPs and some OFPs, and the SFPs recovered faster than others. However the mf-ERG responses remained low in part after complete SFP recovery. Those OFPs might be associated with cone density in AO.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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