Multifocal Choroiditis in a Diabetic Patient

A 48-year-old woman presented with floaters, photopsia, blurred vision and ocular pain in both eyes of a few days’ duration prior to referral. She had a history of diabetes mellitus for 10 years and was being treated with glibenclamide and metformin. On examination, visual acuity was 20/160 and 20/50 in the right and left eyes, respectively with no significant refractive error. Both pupils were normally reactive and no afferent pupillary defect was present. Slit lamp examination disclosed 1+ cell in the anterior chamber, pigmentation of the anterior lens capsule, 2+ nucleus sclerosis and 1+ to 2+ vitreous cells in both eyes. Intraocular pressure was 16 mmHg in both eyes. Fundus examination revealed multiple well-circumscribed creamy-yellow subretinal lesions, mostly distributed in equatorial and peripapillary regions, together with dot and blot retinal hemorrhages, macular edema and florid neovascularization of the optic discs (Fig. 1). Fluorescein angiography (FA) demonstrated early hypoand late hyperfluorescence of the lesions (Fig. 2). Apart from diffuse optic disc leakage, macular leakage was also notable. On indocyanine green (ICG) angiography, the lesions remained hypofluorescent through all phases of the angiogram (Fig. 3). Laboratory investigations including VDRL, serum angiotensin-converting enzyme level and skin tuberculin test (STT), were within normal limits and HLA-A29 was negative. Chest X-ray was also unremarkable.