Advantages:

A successful corticosteroids treatment in a case of macular edema  (ME) secondary to choroidal neovascularization (CNV) associated with choroiditis and congenital toxoplasmosis chorioretinal scars.

Methods:

A 38-years-old myopic patient, affected to Beta Thalassemia Minor (HbA2 5.5%) presented sudden onset of photopsia, blurred vision in left eye (LE). The best visual acuity correct (BVCA) was 0.3. Clinical examination showed a normal anterior segment. Fundus examination revealed a congenital Toxoplasmosis scar in temporal field, without vitreitis. The instrumental examinations showed ME secondary to CNV and punctate and multifocal hyperfluorescence. Indocyanine angiogram showed widespread, deeper spots involving the inner choroid and surrounding the optic nerve there was a collarette of hypofluorescent spots. Blood tests were normal, infectious and inflammatory markers were negative. During the follow up (September/2009- December 2011) ophthalmological clinical examination, Autofluorescence (FAF), Optical Coherence Tomography (OCT) were performed each month. Fluorescein and indocyanine angiography were performed when there was a reactivation of inflammation. In the acute phase the therapy was Deltacortene 75 mg per day for 1 week, 50 mg for 1 week, 25 mg for 1 month.

Effectiveness / Safety:

After therapy the BCVA was 1.0. The OCT showed reduction of the RPE alteration. ICGA and FAG showed disappearance of retinal and choroidal lesions. During the follow up there were 3 episodes of blurred vision associated with choriocapillaris inflammation.

Take home message:

Autofluorescence allows recognizing the first signs of choroiditis. Thus we can quickly start the treatment and use low doses of steroids.