Neuroretinitis: Etiologies, Treatment Approaches, and Visual Outcomes from a Tertiary Referral Center.

PURPOSE: To evaluate the clinical characteristics, etiologies, treatment strategies, and visual outcomes in patients diagnosed with neuroretinitis at a tertiary referral center.

METHODS

This retrospective case series included 21 patients (25 eyes) diagnosed with neuroretinitis between January 2014 and February 2025. All patients underwent comprehensive ophthalmologic examination, multimodal imaging, and extensive laboratory investigations. Treatment regimens were individualized based on suspected or confirmed etiologies.

RESULTS

The mean age of patients was 31.9 ± 15.5 years. Bartonella henselae infection was the most frequent etiology (42.9%), followed by Toxoplasma gondii infection (14.3%) and Behçet's disease (BD)-associated neuroretinitis. Despite a thorough evaluation, 33.3% of cases were classified as idiopathic. Empirical antibiotic therapy was initiated in most patients (85.7%) pending serological results. All patients received systemic corticosteroids, and selected cases required immunosuppressive therapy, including azathioprine or biologic agents. The mean baseline best-corrected visual acuity was 0.84 ± 0.67 logMAR, improving significantly to 0.08 ± 0.17 logMAR at final follow-up (p < 0.001). Visual recovery was favorable in nearly all eyes, with a final BCVA >0.3 logMAR in only two cases.

CONCLUSION

This case series highlights the etiologic spectrum encountered in a tertiary referral center and underscores the importance of careful exposure history and targeted serologic testing in facilitating etiologic differentiation. Neuroretinitis may also represent an ocular manifestation of systemic inflammatory diseases such as BD, while empirical treatment may be considered when infectious causes cannot be confidently excluded at presentation.