Purpose: To describe idiopathic multifocal choroiditis with chorioretinal atrophy developing choroidal flow voids on optical coherence tomography angiography that preceded a recurrence of the disease.
Methods: Case report.
Results: A 24-year-old woman presented with visual field changes and occasional photopsias. Systemic workup for syphilis, tuberculosis, and sarcoidosis was negative. Clinical findings and multimodal imaging were consistent with idiopathic multifocal choroiditis with chorioretinal atrophy, complicated by inactive choroidal neovascularization in her right eye. She was treated with systemic corticosteroids with a taper over 3 months without change in her examination. She was then stable for 2 years. At that point, the patient experienced increased photopsias, but her examination result was unchanged. Optical coherence tomography angiography showed multiple flow voids in the choroid that were not present 6 months ago. No lesions were seen on other imaging modalities. Structural optical coherence tomography showed some subtle hyperreflectivity throughout the choroid that was previously absent. Given the unknown significance of these flow voids, the patient was asked to return for follow-up in 1 month. Her photopsias improved, and her vision remained normal. On repeat examination after 1 month, the patient had developed a few subtle yellow lesions in the superonasal quadrant of the left eye. There were no macular lesions. The repeat optical coherence tomography angiography revealed that the flow voids were fading.
Conclusion: Imaging findings using optical coherence tomography angiography in our patient with idiopathic multifocal choroiditis showed choroidal flow voids that preceded clinical recurrence, not detected by other imaging modalities. Future studies should determine whether optical coherence tomography angiography can be used to detect subclinical lesions preceding clinical recurrences of idiopathic multifocal choroiditis.