Background: We describe a case of nodular posterior scleritis with intense subretinal exudation.
Case: A 54-year-old man was referred to our hospital on the third day of onset, complaining of general malaise, distorted vision, and ocular pain in his left eye. Left visual acuity was 0.8 (n. c. ) and left intraocular pressure was 16 mmHg. He had minimal conjunctival injection, and there was no inflammation in the anterior chamber and vitreous. Fundus examination showed white lesion of one optic disc diameter in size with retinal hemorrhage below the macula. A choroidal swelling lesion with serous retinal detachment was observed at the lesion. Optical coherence tomography (OCT) showed significantly thickened choroid under exudation and fibrin precipitation in the subretinal cavity. In addition, multiple punctate hypofluorescent spots appeared in the late stage of indocyanine green fluorescence angiography (ICGA). Contrast-enhanced computed tomography (CT) of the head to pelvic cavity showed that the sclera on the posterior wall of the left eye was locally thickened and bright. There were no lesions suspected to be malignant tumors throughout the body. Therefore metastatic choroidal tumors were ruled out. No other significant findings were found on a systemic examination, and the patient was diagnosed with posterior scleritis. Oral administration of prednisolone 60 mg was started. The choroidal ridge shrank rapidly and serous retinal detachment quickly disappeared. In addition, the multiple punctate hypofluorescent spots seen in the late stage of the ICGA at the first visit were appeared. The findings were also noted in the subsequent near-infrared autofluorescence. We reduced the dose of the steroids until these findings disappeared after about 4 months. A small atrophic lesion of the outer retina was remained, visual acuity improved.
Conclusions: We experienced a case showing a choroidal mass and satisfying the clinical features of nodular posterior scleritis. The findings of near-infrared autofluorescence helped understanding of the disease.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 126: 27-35, 2022.