First Author: R.Couceiro PORTUGAL
Co Author(s): C. Loureiro S. Vaz-Pereira 0 0 0 0 0 0 0 0 0
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Solar maculopathy (SM) is characterized by a yellowish foveal lesion after direct and prolonged solar exposure. We aim to describe the clinical and imaging features in SM.
Teaching hospital, terciary referral center.
Case report of a 42 year-old male that presented with acute, bilateral and painless vision loss after staring directly at the sun. Complete ophthalmic examination, Amsler grid evaluation, colour fundus photographs, static perimetry (M2 macula program), spectral-domain optical coherence tomography (SD-OCT), enhanced depth imaging OCT (EDI-OCT) and fundus autofluorescence (FAF) was obtained.
Baseline best corrected visual acuity (BCVA) was 20/25 bilaterally with a normal biomicroscopy. On fundoscopic examination, a small, yellowish, round foveal lesion could be seen in both fundi. Amsler grid testing revealed a bilateral central scotoma, but no changes were found on static perimetry. SD-OCT showed a full-thickness hyperreflectivity that extended from the inner retinal layers to the retinal pigment epithelium (RPE); a localized disruption of the ellipsoid layer and RPE was also noted. An assimetry in the subfoveal choroidal thickness between the two eyes was evident on EDI-OCT, with the left eye showing a thicker choroid up to 408 µm. No treatment was warranted and a week after presentation SD-OCT showed resolution of the foveal hyperreflectivity. At 3 months follow-up, BCVA was 20/20 bilaterally, no central scotoma was noted on Amsler grid testing and fundoscopy findings revealed attenuation of the foveal lesions. FAF was unremarkable. However, on SD-OCT, a bilateral subfoveal focal disruption persisted at the level of the ellipsoid layer and RPE, with an intact external limiting membrane. Control EDI-OCT showed the same features identified at baseline.
Multimodality imaging is useful in solar maculopathy, highlighting structural changes during the acute and convalescent phases of the disease. The acute phase SD-OCT findings of full-thickness foveal hyperreflectivity represent a very initial and severe stage of SM, virtually pathognomonic of this condition. The imaging analysis shows that, despite the complete functional resolution, irreversible damage persists. The EDI-OCT changes at the choroid may represent an extension of the inflammatory process from the outer retina to the choroid. Nevertheless, further studies are needed to fully understand these findings.