BACKGROUND: Multifocal choroiditis is a recurrent inflammatory disease of the retina, retinal pigment epithelium, and/or the inner choroid. It is characterized by bilateral vitreous inflammation with lesions at the level of the RPE and choriocapillaris. Other signs include cystoid macular edema, large temporal field defects that often do not correspond to the fundus lesions, optic disc edema, optic atrophy, and secondary choroidal neovascular membranes. The disease usually affects Caucasian females in the third decade of life. Symptoms include decreased central vision, central metamorphopsia, floaters, and photophobia. Treatment of the condition includes topical, systemic, and/or periocular steroids with varying degrees of success.
CASE REPORT(S). A 49-year-old white female presented to our clinic with the chief complaint of blurry vision OU (OD>OS) for three weeks and left eye pain. She had a significant ocular history for recurrent multifocal choroiditis with two prior episodes ten and two years ago. She was treated successfully with oral and topical steroids in both instances. Her visual acuity on initial examination was 20/30 OD and 20/40 OS. Confrontational fields showed a temporal defect, OS. There was an extensive anterior chamber reaction with mutton fat keratic precipitates, OU. The dilated fundus exam revealed a vitritis (OS>OD), mild disc edema OU, and multiple punched out lesions in the posterior pole and mid-periphery. She was diagnosed with a recurrent multifocal choroiditis and started on topical steroids and a cycloplegic. On subsequent visits, she was given subtenons steroid injections OU. After two months of follow-up, visual acuity improved to 20/25- OD and 20/30 OS with minimal anterior chamber reaction, minimal vitritis, resolved optic disc edema, and no active chorio-retinal lesions.
CONCLUSIONS. Multifocal choroiditis can present with a variety of signs and symptoms and can respond to anti-inflammatory treatments with varying success. Our patient represents a case of recurrent multifocal choroiditis with classical signs and symptoms. This patient also showed a favorable response to topical steroids and subtenons steroid injections.