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JAMA Ophthalmology Clinical Challenge
December 13, 2018

Choroidal Infiltrate of Unknown Cause

Author Affiliations
  • 1Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
JAMA Ophthalmol. 2019;137(2):222-223. doi:10.1001/jamaophthalmol.2018.4488

A woman in her late 50s reported right eye visual field changes. Review of medical history revealed lumpectomy and radiotherapy for breast cancer 6 years prior. Visual acuity was 20/160 OD (her baseline due to amblyopia) and 20/20 OS. Pupillary function was normal. The anterior chamber and vitreous were quiet. Fundus photographs showed optic nerve edema and a peripapillary choroidal infiltrate in the right eye. Swept-source optical coherence tomography (OCT) demonstrated retinal thickening with cystoid abnormalities, subretinal hyperreflective material consistent with fibrosis, and choroidal thickening in the right eye (Figure 1). Optical coherence tomography of the optic nerve head in the right eye demonstrated 360° peripapillary nerve fiber thickening and diffuse nerve head elevation. Fluorescein angiography demonstrated staining with minimal leakage in the temporal peripapillary retina of the right eye.

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