Systemic Corticosteroids Therapy in the Management of Acute Zonal Occult Outer Retinopathy

Figure 2

Color fundus in case 5 shows tessellated fundus in both eyes with temporal conus (a). Optical coherence tomography showed normal ellipsoid zone in the right eye (b, upper) and disrupted ellipsoid zone at the macular and peripapillary area with central sparing in the left eye (b, central) in the acute stage. Recovery of the ellipsoid zone was noted at the macular area 4 months later; however loss of the outer nuclear layer and the ellipsoid zone adjacent to the disc was also noted (b, lower). Visual field test at initial presentation showed dense central, temporal scotoma, and faint circumferential peripheral visual field defect in the left eye (c, upper). Small nasal scotoma and faint upper nasal scotoma were also noted in the left eye. The visual field defect in the left eye reduced a little 3 months later after oral prednisolone treatment (c, middle). An enlarged visual defect was noted after tapering of the steroids (c, lower). Fluorescein angiograph showed mild segmental periphlebitis in the left eye at the disease onset (d, upper). Indocyanine green angiography taken concurrently revealed some suspicious hypofluorescent spots at the posterior pole and arcade area in the left eye (d, lower). Fundus autofluorescence (FAF) imaging at acute phase showed some suspicious hyperautofluorescent spots at upper aspect of disc (e, left). Follow-up FAF 2 years later showed diffuse hypoautofluorescence at peripapillary area and area lower to the lower vascular arcade (e, right).

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