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Subretinal neovascularization secondary to choroidal septic metastasis from acute bacterial endocarditis
1Hôpital Jules Gonin, Département d'Ophtalmologie, Université de Lausanne, Switzerland.
Abstract:
The clinical features of an infective embolic choroidopathy are described, from its early onset to late complications in a 45-year-old man with acute Staphylococcus aureus endocarditis of the aortic valve. Initial fundus examination revealed, in addition to fresh choroidal lesions, stigmata of a previous embolic episode secondary to endocarditis from Actinobacillus actinomycetemcomitans. The choroidal lesions were extremely asymmetrical, with a clear preference for localization in the left eye. Similar ocular findings were seen in a 78-year-old female with mitral valve prolapse and acute S. aureus endocarditis. In this case, however, choroidal involvement from septic emboli spread was bilateral and roughly symmetrical. Choroidal neovascular membranes arising in scars from choroidal septic emboli occurred in the macular area of the left eye of both patients, 10 months and 5 years after embolization, respectively.
Insights
Infective embolic choroidopathy from bacterial endocarditis can cause asymmetrical or symmetrical ocular lesions. Late complications include choroidal neovascularization in the macula.
Area of Science:
- Ophthalmology
- Cardiology
- Infectious Diseases
Background:
- Bacterial endocarditis, particularly Staphylococcus aureus, can lead to septic emboli.
- Septic emboli can travel to the choroid, causing infective embolic choroidopathy.
- Previous embolic episodes from other bacteria like Actinobacillus actinomycetemcomitans may also be present.
Observation:
- Clinical features of infective embolic choroidopathy were studied in two patients with acute bacterial endocarditis.
- A 45-year-old male with Staphylococcus aureus endocarditis presented with asymmetrical fresh choroidal lesions, predominantly in the left eye.
- A 78-year-old female with Staphylococcus aureus endocarditis and mitral valve prolapse showed bilateral, symmetrical choroidal involvement.
Findings:
- Choroidal lesions from septic emboli can be asymmetrical or symmetrical depending on the case.
- Both patients developed choroidal neovascular membranes in the macular area.
- These neovascular membranes arose in scars from previous choroidal septic emboli, occurring 10 months and 5 years post-embolization.
Implications:
- Infective embolic choroidopathy is a potential complication of bacterial endocarditis.
- Ocular findings can vary in symmetry and later develop neovascular complications.
- Early detection and management of endocarditis are crucial to prevent severe ocular sequelae.