Fundus Autofluorescence and OCT in the Management of Progressive Outer Retinal Necrosis

A 41-year-old woman with AIDS presented with progressive nasal visual field loss in her right eye. Ophthalmic examination revealed widespread retinal opacification with hemorrhage consistent with progressive outer retinal necrosis, which was confirmed by polymerase chain reaction for varicella zoster virus DNA. The patient was treated with intravenous and intravitreal foscarnet and ganciclovir with improvement clinically. Optical coherence tomography (OCT) and fundus autofluorescence imaging revealed progressive changes indicative of widespread retinal pigment epithelial (RPE) and outer retinal dysfunction. OCT showed progressive changes in macular architecture, including neurosensory elevation, cystoid macular edema, and severe outer retinal necrosis, at initial examination and 1 week and 1 month of follow-up. Fundus autofluorescence revealed stippled hyperfluorescence within extensive zones of hypofluorescence, which progressed during follow-up. OCT and fundus autofluorescence was useful in the characterization of the RPE and retinal anatomy in this patient with progressive outer retinal necrosis.