1. Inflammatory choroidal neovascularization
Sana Khochtali, MD
Wafa Ammari, MD
Samah Mbarek, MD
Riadh Messaoud, MD
Department of ophthalmology
Fattouma Bourguiba University Hospital
Tahar Sfar University Hospital
Faculty of Medicine, University of Monastir, Monastir, Tunisia

2. Ocular History A 16-year-old girl
February 2011 : vision blurring, toxoplasmic retinochoroiditis OS treated with azithromycin by local ophthalmologist
August 2011: vision loss, OS

3. August 2011 Visual acuity 20/20 OD, 20/200 OS
No AC inflammatory reaction OS
Intraocular pressure : 15 mmHg OU
1+ vitreous cells, no vitreous haze OS
OD : unremarkable

4. Fundus photograph shows an atrophic chorioretinal scar (arrow), and a slightly prominent grayish lesion (arrowhead), superotemporal to the fovea
The patient was diagnosed as having active recurrent toxoplasmic retinochoroiditis
The patient was treated with the association of pyrimethamine, azithromycin, and oral prednisone

5. One month later
Visual acuity: 20/200, same fundus findings

6. Fluorescein AngiographyB
Early-phase fluorescein angiogram (A) shows hyperfluorescent, well-defined juxtafoveal choroidal neovascular membrane surrounded by retinal hemorrhages. Late-phase fluorescein angiogram (B) shows a profuse leakage from the neovascular membrane

7. Optical Coherence Tomography
OCT showed a fusiform thickening of the RPE-choriocapillaris band, corresponding to the choroidal neovascular membrane (arrow), associated with the presence of intraretinal fluid

8. Final diagnosis
Inflammatory choroidal neovascularization secondary to ocular toxoplasmosis
The patient received a single intravitreal injection of bevacizumab (1.25 mg)

9. Follow-up Visual acuity: 20/32
Resorption of the intraretinal fluid (OCT)
At 18-month follow-up : no recurrence of the choroidal neovascularization
OCT shows a subretinal hyperreflective dome-like lesion without intraretinal fluid, consistent with inactive scar

10. Conclusion
The diagnosis of inflammatory choroidal neovascularization secondary to ocular toxoplasmosis may be challenging
Careful clinical examination, fluorescein angiography
and OCT provide clues for the definitive diagnosis
A single intravitreal anti-VEGF injection (without anti-toxoplasmic medications) may be sufficient to control neovascularization