Choroidal neovascularization secondary to choroidal nevus simulating an inflammatory lesion
A 16-year-old girl was referred to our clinic with a diagnosis of neuroretinitis or juxtapapillary chorioretinitis. The patient had a 3-week history of decreased vision and metamorphopsia in her left eye. Her medical and family history were unremarkable. There was no history of trauma or high myopia. Before referral, systemic work-up for tuberculosis, sarcoidosis, syphilis, Lyme disease, brucellosis, and toxoplasmosis was negative. At our initial visit, best-corrected visual acuity was 20/20 in the right eye and counting fingers in the left eye. There was a mild relative afferent pupillary defect in the left eye. Biomicroscopic examination was within normal limits. There was no cellular reaction in the anterior chamber or vitreous cavity. The intraocular pressure was 16 mmHg in both eyes. Fundus examination of the left eye revealed a juxtapapillary, elevated, white chorioretinal lesion consistent with CNV that was associated with exudation and retinal edema []. The juxtapapillary choroidal nevus underlying CNV was not visible with color fundus photography [], but we were able to detect it with the brightest illumination of the indirect ophthalmoscope. Fundus fluorescein angiography (FFA) demonstrated extrafoveal, juxtapapillary CNV, and late diffuse hyperfluorescence superior to this lesion. Optic disc was normal in all phases of the angiography [Fig. –]. Optic coherence tomography (OCT) confirmed CNV with overlying intraretinal cysts and minimal subretinal fluid. A diagnosis of juxtapapillary CNV associated with a choroidal nevus was made. After a written informed consent was obtained, three consecutive monthly intravitreal bevacizumab (1.25 mg/0.05 ml) injections were performed. After treatment, best-corrected visual acuity improved to 20/50. CNV appeared inactive and smaller in size with complete resolution of exudation exposing an underlying choroidal nevus with 6 × 6 × 2.6 mm in dimensions []. OCT demonstrated gradual resolution of subretinal fluid and intraretinal cysts []. FFA revealed burnt-out fibrotic CNV with late staining and juxtapapillary hypofluorescence due to underlying choroidal nevus []. The lesion was still inactive and final visual acuity was stable throughout 2 years of follow-up.