The evolution of an active solitary idiopathic choroiditis (focal scleral nodule): a case report of the natural course and a review of the literature.

BACKGROUND: To describe the clinical course of an active solitary idiopathic choroiditis (focal scleral nodule) that nearly resolved over six weeks without intervention. CASE PRESENTATION: An 18-year-old man presented to the emergency department with headaches and new onset central scotoma in the right eye. Visual acuity was 20/20 in both eyes. Fundus examination revealed an amelanotic choroidal lesion with associated shallow subretinal fluid. It measured 6.1 × 6.3 × 1.4mm on A- and B-scan. Evaluation for systemic inflammatory and infectious diseases was negative. A week later, the lesion remained stable, and a month later, there was improvement of the lesion with a decrease in size on OCT and exam and resolution of the subretinal fluid suggesting that the lesion had become inactive. CONCLUSIONS: Solitary idiopathic choroiditis (Focal scleral nodule) is a rare condition characterized by inflammatory granulomatous reaction. This case report sheds light on the unknown natural course of a solitary idiopathic choroiditis (focal scleral nodule).

Clinical Features and Multimodal Imaging Findings of Focal Scleral Nodule: Potential Association between Lesion Characteristics and Age.

OBJECTIVE: To describe the clinical course and anatomic features of focal scleral nodules (FSNs) based on their clinical characteristics and multimodal imaging findings and analyze their potential associations with the patient's age. DESIGN: Single-center, retrospective, observational case series. SUBJECTS: Twenty-three lesions of 23 patients with FSN. METHODS: Clinical characteristics were analyzed, and multimodal imaging was performed, including color fundus photography, OCT, fundus autofluorescence imaging, near-infrared imaging, B-scan ultrasonography, fluorescein and indocyanine green angiography, and OCT angiography of FSNs. MAIN OUTCOME MEASURES: Qualitative features, including the slope of anterior curvature (curvature of the dome shape is less than nodular curvature, which is less than volcanic curvature; i.e., volcanic curvature has the steepest slope), retinal pigment epithelium (RPE) status, and fluid compartments, were analyzed. Quantitative measurements, including maximum linear basal diameter, maximum horizontal length at the choroidoscleral border, maximum vertical length (Vmax) from the choroidoscleral border, and choroidal thickness, were analyzed. RESULTS: The mean age at presentation was 44 ± 17 years (range, 4-68 years), and the mean follow-up duration was 32.2 ± 29.5 months. On OCT, all lesions were confined to the sclera. Patients with volcanic or nodular anterior curvature were younger than those with the dome-shaped phenotype (35 ± 19 years vs. 52 ± 9 years, respectively; Mann-Whitney U test; P = 0.015). The Spearman rank correlation analysis displayed a significant correlation between age at diagnosis and Vmax (r = -0.466; P = 0.025). The Wilcoxon matched paired t test for the patients demonstrated a significant decrease in Vmax at the final follow-up visit (initial, 555 ± 228 µm vs. final, 517 ± 202 µm, respectively; P = 0.028). We observed subretinal fluid, intraretinal fluid, pigment epithelial detachment, and severe outer retinal atrophy in a relatively older population with sustained nodular or volcanic anterior curvature (age, 52 ± 7 years; range, 43-60 years). One lesion diagnosed in a patient aged 4 years demonstrated spontaneous regression. CONCLUSIONS: Young patients tended to have protruded lesions (high Vmax) with nodular or volcanic anterior curvature. Older patients manifested the dome-shaped phenotype, and those with sustained nodular or volcanic curvature tended to develop fluid compartments or atrophic changes of the overlying RPE and retina because of possible chronic mechanical compression. Thus, there could be a significant association between FSN phenotype and age.

Multimodal Imaging Features of Focal Scleral Nodule.

This article describes a 63-year-old woman with a yellow-white mass in the inferior juxtapapillary region discovered on routine ocular examination. She was diagnosed as solitary idiopathic choroiditis (SIC) after an extensive ocular examination. SIC is a rare condition of unknown aetiology that can sometimes be mistaken as inflammatory processes or intraocular tumors. Solitary idiopathic choroiditis is suspected clinically and the diagnosis is established with multimodal imaging, so CIS has been renamed focal scleral nodule because of the scleral location.