Indolent nonprogressive multifocal choroidal lesions.

Purpose: We present a case series of four patients with unilateral, nonprogressive, yellow or white choroidal lesions of unknown etiology.

Methods: Four healthy patients were referred to an academic medical retina practice for unusual fundus findings in one eye only. Both eyes of all four patients underwent clinical examination and retinal imaging, including fluorescein angiography, indocyanine green imaging, and optical coherence tomography. The outcome of this series was based on the clinical course of these patients and the features of the retinal images.

Results: The differential diagnosis based on the clinical appearances for these unknown cases includes birdshot chorioretinopathy, lymphoma or reactive lymphoid hyperplasia, metastases, orbital and intraocular pseudotumor, and bacterial or fungal infection. Extensive workups for these clinical entities including HLA-A29, angiotensin-converting enzyme level and computed tomography of the chest, liver function testing, magnetic resonance imaging of the brain, and orbital ultrasound have remained negative.

Conclusion: Clinical and imaging characteristics for the four patients include absence of intraocular inflammation, late staining of lesions on fluorescein angiography, and hypofluorescence of lesions on indocyanine green. Lesions were not visible in the retina or retinal pigment epithelium using time domain optical coherence tomography. However, enhanced depth imaging spectral-domain optical coherence tomography imaging available for one patient suggests that these lesions are localized to the choroid; further interpretation of this advanced imaging technique will likely prove useful in the future. The patients' clinical course has remained nonprogressive with no changes over a prolonged period of observation. These cases could represent atypical manifestations of known retinal disease diagnoses or variations of a new chorioretinal disease process.