Abstract
Purpose :
Optical Coherence Topography Angiography (OCT-A) is a dye-free imaging tool to visualize retinochoroidal vessels. While OCT-A has been suggested as an adjunct tool for cat-scratch disease (CSD), literature on its use for CSD neuroretinitis is limited. Here, we present a case of acute CSD neuroretinitis and the associated findings in macula, and the optic disc visualized with OCT-A.
Methods :
A 24-year-old male presented with decrease in vision for a week and a “constant oval shaped dot” in the right eye. He also complaint of generalized pain around that eye and severe headaches. On further history, the patient recalled being scratched by a cat on the hand 2 weeks prior to presentation, following which he developed excessive right eye tearing with a clear discharge, which had since resolved. He was further evaluated with a clinical examination and ocular imaging.
Results :
On examination, his visual acuity (VA) was 20/60 and the fundus examination revealed subretinal fluid in the macula as well as 3+ optic disc edema. Rest of the examination was unremarkable. His Optical Coherence Topography (OCT) showed loss of foveal contour, moderately-severe subretinal fluid, thickened neurosensory retina with hyperreflective outer plexiform layer, peripapillary exudates at Henle’s layer, and vitreous hyperreflectivity. Fluorescein angiogram (FA) showed optic nerve hyperfluorescence and engorged vessels (especially veins). A swept-source OCT-A (Topcon DRI OCT Triton, Japan) revealed dilated vessels with rare telangiectasias at the optic disc and increased tortuosity but reduced density of peripapillary capillaries. The diagnosis of CSD neuroretinitis was confirmed with elevated antibody titers to Bartonella Henselae and the patient was started on oral doxycycline. At 2-week follow-up visit, there was an improvement in VA combined with a significant decrease in subretinal fluid and optic disc edema. The OCT showed mild subretinal fluid, improved vitreous hyperreflectivity, and minimal hyperreflectivity of outer plexiform layer. FA showed improvement in optic nerve hyperfluorescence with normal vessel diameter. The OCT-A showed improvement in optic disc vessel abnormalities as well as peripapillary vessel tortuosity and density.
Conclusions :
OCT-A can serve as an adjunct tool to assess response to treatment in acute CSD neuroretinitis by evaluating subtle changes in vasculature at the optic disc and retinochoroid.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.