Multimodal imaging in a patient with sequential bilateral sarcoid intraretinal granuloma

A 24-year-old male patient with an unremarkable medical history presented with blurred vision in the right eye (RE) for a few weeks. The best-corrected visual acuity (BCVA) was 20/400 in the RE and 20/20 in the left eye (LE). Ophthalmic examination showed 3+ vitreous cells, snowballs, and multifocal segmental periphlebitis in both eyes. There was a one-disc diameter white lesion inferotemporal to the optic disc associated with hard exudates in the RE. Multimodal imaging findings were consistent with intraretinal granuloma. Workup led to the diagnosis of probable ocular sarcoidosis. Three years later, the patient developed an intraretinal granuloma involving the macula in the fellow eye. Intravitreal antivascular endothelial growth factor was given in association with anti-inflammatory therapy. Final BCVA was 20/200 in the RE and 20/1000 in the LE.