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June 2011

Immune Choroiditis Following Acute Retinal Necrosis—Reply

Author Affiliations

Author Affiliations: St Thomas' Hospital, London, England.

Arch Ophthalmol. 2011;129(6):805-820. doi:10.1001/archophthalmol.2011.110

In reply

We thank Dr Basu for his comments regarding our article.1 The process of phthisis in case 1 developed, as in many phthisical eyes, with continued panuveitis, ciliary body shutdown, and eventual corneal decompensation. Treatment for this patient involved both topical and systemic corticosteroids, as in many phthisical eyes. Dr Basu is incorrect in suggesting that these 2 cases are likely to represent different disease entities because both cases had ARN in the contralateral eye and both cases developed deep retinal/choroidal lesions with associated ocular inflammation. The outcome of these 2 patients was indeed different; 1 patient developed phthisis and the other developed a choroidal neovascular membrane. This does not form the basis to conclude that the disease processes are different. Choroidal neovascular membranes are not uncommon following chorioretinitis and can do well without treatment as seen in our patient. As explained in the discussion section of this manuscript, we appreciate that these 2 cases may be a spectrum of sympathetic ophthalmia but the atypical appearance allow us to hypothesize a different mechanism to these findings. We agree that previously reported choroiditis following ARN was contiguous with the previous area of ARN, but we only use this example to explain the possible mechanism of these choroidal lesions in our cases and the possibility of subthreshold presentation of ARN. Without histological evidence and further animal studies, the findings from our 2 patients will not prove or disprove the hypothesis. Therefore, our manuscript does not conclude the pathological origin of these findings, but merely attempt to offer the possible mechanisms for these 2 unusual cases.