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Photo Essay
July 2002

Acute Annular Outer Retinopathy

Arch Ophthalmol. 2002;120(7):993. doi:10.1001/archopht.120.7.993

A 58-YEAR-OLD white woman was examined because of a 5-day history of an enlarged blind spot in her left eye. She was taking azathioprine, 50 mg once daily, for Crohn disease. Her visual acuity was 20/30 OU. A peripapillary, annular gray-white ring was seen in the left fundus (Figure 1). A week later, the ring had enlarged to involve the fovea (Figure 2). Her visual acuity deteriorated to hand movements, and she developed a left afferent pupillary defect. Photopic electroretinographic responses were delayed and reduced. A fundus fluorescein angiogram showed a hypofluorescent ring with a hyperfluorescent area within (Figure 3, Figure 4, and Figure 5), which was also seen in the late phase (30 minutes) of the indocyanine green angiogram (Figure 6). The optic disc appeared normal with no leakage of dye. Acute annular outer retinopathy was diagnosed, and treatment was begun with oral prednisolone, 60 mg once daily, and acyclovir, 400 mg 4 times daily. The peripapillary ring faded during a period of 6 weeks, but no visual improvement was noted.

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