Posterior Segment Involvement in Subacute Sclerosing Panencephalitis: Clinical Features and Outcomes

To characterize posterior segment involvement in subacute sclerosing panencephalitis (SSPE) using clinical and multimodal imaging findings.

Retrospective evaluation of three patients with SSPE presenting with posterior segment findings. Ophthalmic examination, fundus photography, fundus fluorescein angiography (FFA), optical coherence tomography (OCT), neurological assessment, and clinical outcomes were reviewed.

Three patients (aged 10, 16, and 22 years) demonstrated variable posterior segment involvement, including macular chorioretinitis, retinal pigment epithelium (RPE) alterations, macular edema, superficial hemorrhages, vascular dilatation, subretinal membrane formation, serous retinal detachment, and macular scarring. In two cases, ocular findings preceded or contributed to the suspicion of SSPE. One patient initially presented with visual complaints and subtle neuropsychiatric symptoms, leading to a delayed neurological diagnosis confirmed by electroencephalography and cerebrospinal fluid analysis. OCT revealed macular edema, retinal thinning, atrophy, and a characteristic patchy intraretinal degeneration pattern resembling a moth-eaten appearance in affected areas. Partial visual improvement was observed in one patient following treatment with levetiracetam, isoprinosine, and interferon beta-1a, whereas two patients showed neurological deterioration and died within four months and two years, respectively.

Posterior segment findings in SSPE are heterogeneous and may precede neurological manifestations. Multimodal imaging, particularly OCT and FFA, provides valuable diagnostic insights. Early recognition of these ocular features may facilitate timely diagnosis and management of SSPE.