Choroidal lesions in varicella zoster virus uveitis

Abstract

Purpose: To evaluate choroidal lesions with spectral domain optical coherence tomography (SD-OCT) scan in varicella zoster virus (VZV) uveitis. Methods: VZV-uveitis cases which underwent OCT scan for choroidal lesions were studied. SD-OCT scan passing through these lesions was studied in detail. Subfoveal choroidal thickness (SFCT) during active and resolved stages was studied. Angiogaphic features were studied where available. Results: Thirteen out of 15 cases had same-sided herpes zoster ophthalmicus skin rashes. All except three patients had old or active kerato-uveitis. All eyes demonstrated clear vitreous and a single or multiple hypopigmented orangish-yellow choroidal lesions. The number of lesions remained unchanged during the follow-up on clinical examination. SD-OCT over lesions ( n = 11) showed choroidal thinning ( n = 5), hyporeflective choroidal elevation during active inflammation ( n = 3), transmission effects ( n = 4), and ellipsoid zone disruption ( n = 7). The mean change in SFCT ( n = 9) after resolution of the inflammation was 26.3 μm (range: 3–90 μm). Fundus fluorescein angiography showed iso-fluorescence over lesions in all ( n = 5), but indocyanine green angiography ( n = 3) showed hypofluorescence at lesions. Mean follow-up was 1.38 years (range: 3 months–7 years). De-novo appearance of choroidal lesion during the first relapse of VZV-uveitis was captured in one case. Conclusion: VZV-uveitis can cause focal or multifocal hypopigmented choroidal lesions with thickening or scarring of choroidal tissue, depending on the disease activity.

Bilateral Vitiligo-Like Depigmentation of Choroid and Retinal Pigment Epithelium Associated with Ipilimumab-Nivolumab Therapy for Metastatic Cutaneous Melanoma

“…Other processes can present with hypopigmented choroidal lesions and should be considered when differentiating more complex ocular manifestations. For example, varicella zoster has been associated with multiple choroidal hypopigmented lesions and uveitis, although the majority of cases present with typical herpes zoster ophthalmicus skin rashes [ 7 , 8 ]. Shields et al [ 9 ] reported on 4 patients without active oncologic diseases presenting with choroidal vitiligo masquerading as choroidal nevi.…”