I read with interest the article on immune choroiditis following contralateral acute retinal necrosis (ARN) by Wong et al.1 The authors have proposed an immune-mediated mechanism for the development of choroiditis lesions following previous ARN in the contralateral eye. However, certain issues need to be resolved to take this hypothesis forward.
As mentioned by the authors, the eyes with immune choroiditis in the 2 cases had significant differences in their clinical course. In case 1, the choroiditis progressed despite antiviral and anti-inflammatory (apparently inadequate) treatment. It is unclear how the condition deteriorated from the clinical picture shown in Figure 1D to a state of phthisis. The authors have not mentioned whether the patient received any treatment during this period. In case 2, the choroidal lesions resolved spontaneously without any treatment. Even the choroidal neovascular membrane in that eye resolved by conservative management (possibly observation). It is therefore likely that the lesions in both the patients represented different disease entities unrelated to ARN.
Basu S. Immune Choroiditis Following Acute Retinal Necrosis. Arch Ophthalmol. 2011;129(6):805-820. doi:10.1001/archophthalmol.2011.109