OCT-Angiography Findings in Acute Diffuse Unilateral Subacute Neurorretinitis: A Case Report.

Purpose: To report multimodal imaging findings in acute Diffuse Unilateral Subacute Neuroretinitis (DUSN), emphasizing the potential role of choriocapillaris OCT-angiography (OCT-A) as a biomarker of inflammatory activity and its relationship with visual outcomes.

Methods

We describe the case of a previously healthy 36-year-old male with acute DUSN who presented with progressive, painless visual loss in the right eye. Clinical examination and multimodal imaging, including OCT-A and indocyanine green angiography, were performed before and after treatment with oral albendazole and systemic corticosteroids.

Results

Initial examination under systemic corticosteroid therapy was unremarkable. After corticosteroid tapering, visual acuity declined to 20/160, with the appearance of deep multifocal lesions in the posterior pole consistent with acute DUSN. Multimodal imaging demonstrated early choroidal inflammatory involvement, with multiple no-flow areas in the choriocapillaris on OCT-A showing exact topographic correlation with hypofluorescent spots on indocyanine green angiography. Treatment resulted in partial choriocapillaris reperfusion, regression of inflammatory lesions, and improvement of visual acuity to 20/50. However, ganglion cell complex thickness maps obtained after inflammatory resolution revealed severe, persistent thinning, indicating irreversible neuronal damage.

Conclusions

Choriocapillaris OCT-A may serve as a useful biomarker of inflammatory activity in acute DUSN. This case also highlights that visual prognosis depends critically on prompt diagnosis and early treatment to limit irreversible retinal neuronal damage.