Título

MULTIMODAL IMAGING ANALYSIS OF KYRIELEIS PLAQUES OVER A 3-YEAR FOLLOW UP PERIOD

Objetivo

Kyrieleis plaques (KP) constitute a benign and rare arteriolar manifestation of selected ocular inflammatory diseases. On fundus examination it appears as distinctive yellowish discontinuous deposits inside the walls of retinal arterioles, distributed over long vessel segments and their main branches. Although known for almost a century, pathologic studies ascertaining the precise nature and constitution of KP are still lacking. We report the case of a patient with toxoplasma retinochoroiditis who developed KP and describe the evolution of the vascular lesions over a 3-year follow up period.

Relato do Caso

A 29-year-old female patient presented rapidly progressive visual decline of her left eye (LE). Her visual acuity was 20/400 in the symptomatic eye, and there was anterior chamber cellularity and dense vitritis. An area of extramacular chorioretinal exudation was barely visible, but allowed to establish the diagnosis of ocular toxoplasmosis. We started treatment with sulfamethoxazole+trimethoprim (800mg +160mg) and oral prednisone. One month after treatment, her vitreous began to clear and a striking pattern of discontinuous whitening of branches of the central retinal artery was seen. The anomalous segments were intercalated with areas of normal vessel anatomy and coloration. Absence of leakage or occlusion on fluorescein angiography, and the presence of discreet intraarterial hyperreflective plaques on optical coherence tomography (OCT) helped confirm the diagnosis. On OCT B-scans, there was circumferential hyperreflectivity in affected arteriolar segments with intense back-shadowing, which was maintained with similar intensity throughout follow-up. Flow signals on OCT-A kept stable and full, with a few artifacts of reduced flow attributable to projection of back-shadowing by the hyperreflective plaques.

Conclusão

Kyrieleis plaque is a rare form of inflammatory arteriolar abnormality with a benign course. Our case showed no flow disturbances could be detected on OCT-A over a 3-year follow-up period.