Recovery course of photoreceptor damage in a patient with cat scratch disease neuroretinitis: 2.5-year observation using adaptive optics retinal imaging.

PURPOSE: To assess the course of retinal damage in neuroretinitis associated with cat-scratch disease from the acute treatment phase to long-term follow-up.

OBSERVATIONS: A 29-year-old female diagnosed with seropositive cat-scratch disease neuroretinitis. At the initial visit, her right eye (OD) presented with decreased visual acuity (best-corrected decimal visual acuity, 0.8) and a central scotoma, along with hyperemic swelling of the optic disc, serous retinal detachment, and stellate maculopathy. Treatment with oral clarithromycin and oral prednisolone, starting with 30 mg daily and then tapered, led to complete resolution of these findings within 9 months. An adaptive optics retinal camera (rtx1™) revealed a disrupted photoreceptor mosaic corresponding to a post-detached retinal area, patchy dark spots in the papillomacular bundle, and hyperreflective deposits corresponding to stellate maculopathy. The dark spots and hyperreflective deposits diminished within one year. While photoreceptor mosaic disruption, correlated with disruption of interdigitation zone on OCT, showed gradual improvement, abnormal findings persisted in the papillomacular bundle even at 2.5 years. At the final follow-up, OD cone density remained at 84.7% of OS cone density in the macular temporal region (5° from fovea) (OD: 14,625/mm2, OS: 17,263/mm2) and 66.5% in the macular nasal region (5°) (OD: 12,237/mm2, OS: 18,401/mm2). MP-3 microperimetry (10-2 grid), covering these areas, showed normal retinal sensitivity in both eyes at 2-year follow-up, with no focal defects in the OD.

CONCLUSION: Long-term persistence of photoreceptor damage, even after visual recovery, may occur in cat-scratch disease neuroretinitis even after systemic antibiotic and anti-inflammatory therapies. Adaptive optics imaging is a useful tool for careful observation.