Bilateral Idiopathic Neuroretinitis

Muhammad  Hidayat

doi:10.3889/oamjms.2020.3596

Authors

Muhammad Hidayat Department of Ophthalmology, Faculty of Medicine, Andalas University, Dr. M. Djamil Hospital, Padang, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2020.3596

Keywords:

Neuroretinitis, Ocular bartonellosis, Cat-scratch disease

Abstract

BACKGROUND: Neuroretinitis is a clinical entity characterized by an acute loss of vision associated with disc edema and a star pattern of exudates in the macula. It can be divided into two, those with a specific infectious agent or idiopathic. Most infectious cases are due to cat-scratch disease caused by Bartonella species and other infectious agents. Case with a clear infectious is categorized as idiopathic. Most patients with idiopathic neuroretinitis recover excellent visual acuity with or without intervention. Although the presentation is most often unilateral, bilateral cases of neuroretinitis have been reported.

CASE REPORT: A 20-year-old woman with a 2-weeks history of sudden progressive visual loss both eyes (visual acuity: RE 3/60; LE 20/200). The optic disc was edema and the hard exudate on the macular area. Two weeks follow-up, funduscopic shows a macular star and the optic disc’s edema was reduced. Perimetric test shows general depressed in both eyes. The blood tests and the brain computed tomography scan were normal. She received methyl prednisolone 48 mg for 2 weeks. Eight months follow-up, VA: RE 20/50, LE 20/40 with the pinhole 20/15 in both eyes. The funduscopic still showed edema and slight paling. There was an improvement in central visual acuity after steroid treatment but leave residual abnormal funduscopic.

CONCLUSION: Neuroretinitis is generally self-limited. The visual acuity recovers excellent with the steroid, but the abnormal disc in this case related to a vaso-occlusive mechanism of prelamin arterioles with subsequent disc infraction.

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