Optical Coherence Tomography Angiography Findings in Neuroretinitis – Case Report

Author: Sofia Teixeira (Portugal)

Co-authors: Sofia Cunha Teixeira, Ricardo Machado Soares, Joana da Silva Fernandes, Catarina Cunha Ferreira, Lígia Ribeiro

Purpose

The aim of this study is to examine a clinical case of neuroretinitis. Neuroretinitis is an inflammatory disorder of the eye presenting with optic disc edema and the delayed development of a macular star secondary to optic nerve swelling toward the macular structures. It can be either infectious (including neuroretinitis associated with cat-scratch disease) or non-infectious (including idiopathic). Optical coherence tomography angiography (OCTA) is a new non-invasive imaging tool to assess microvascular retino-choroidal changes. It can also play an important role in the diagnosis and management of optic nerve-related diseases.

Setting/Venue

Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal

Methods

Multimodal imaging in a case of Bartonella Neuroretinitis, including OCTA findings, at presentation and 3-month follow-up.

Results

A healthy 32-year-old female presented with painless visual loss and central scotoma in her left eye (OS) for 3 days. She reported associated headaches and nausea. Best corrected visual acuity was 10/10 in the right eye (OD) and 1/10 in the OS. A left relative afferent visual defect and dyschromatopsia were noticed. Dilated fundus examination revealed right optic disc with blurred nasal edge and diffuse optic disc swelling with peripapillary haemorrhage in OS. Maculae appear normal in both eyes. Brain MRI, lumbar puncture and analytical study were uneventful. Two weeks following the initial symptoms stellate macular exudates developed. Optical coherence tomography (OCT) revealed hyperreflective lesions predominantly in the outer plexiform layer nasally and subfoeval fluid accumulation and OCT angiography showed peripapillary telangiectatic vessels with superficial and deep macular plexus without circulation impairment. When questioned, the patient referred previous contact with a litter of sick cats. Neuroretinitis was concluded, and Cat Scratch Disease (CSD) etiology was confirmed with serologies.

Conlusions

Neuroretinitis is primarily a clinical diagnosis with characteristic findings of unilateral disc edema and a macular star. Given the delayed development of the maculopathy the diagnosis of neuroretinitis may be initially. Multimodal imaging is useful in characterizing and analysing optic disc involvement and associated chorioretinal changes in both typical and atypical clinical presentations. Positive serology for Bartonella henselae is mandatory to establish the definitive diagnosis. OCTA displays finer vascular details of the optic nerve head and superficial and deeper retinal plexus by imaging the dynamic movements of red blood cells. It presents an interesting opportunity to diagnose and to track how the retinal vasculature is affected in patients with in CSD neuroretinitis. More data are needed to establish specific patterns of vascular abnormalities and the extent to which OCTA may aid in the diagnosis and follow-up of neuroretinitis.