Bilateral Combined Retinal Vasculitis With Multiple Cotton Wool Spot-Like Lesions

This retrospective chart review presents a case of bilateral noninfectious retinitis exhibiting cotton wool spot-like lesions, associated with combined retinal vasculitis. A 26-year-old woman with no known systemic illness presented with bilateral combined retinal vasculitis, associated with multiple cotton wool-like lesions along the vessels. Swept-source optical coherence tomography (SS-OCT) revealed a prominent middle limiting membrane (MLM) sign with cystoid macular edema. Fundus fluorescein angiography (FFA) showed blocked hypofluorescence and optic disc leakage, but notably, no vascular leakage. Serological investigations and neuroimaging were unremarkable, except for a positive antinuclear antibody (ANA). Following initiation of oral corticosteroids, the cotton wool spot-like lesions began to resolve within 2 days, accompanied by an increase in hemorrhagic components, which subsequently resolved over 3 weeks. After complete resolution, optic disc pallor and retinal thinning were observed. This rare case of bilateral combined retinal vasculitis with distinctive cotton wool spot-like lesions along the vascular arcades showed a rapid response to corticosteroid therapy and remained clinically quiescent over long-term follow-up.