Purpose: To present a case of indolent, nonprogressive multifocal choroidal lesions and contribute to the limited reports aiding this diagnosis, supplemented by a review of the literature.
Methods: Clinical records of a patient were reviewed alongside relevant literature from PubMed, Cochrane, and Google Scholar.
Results: A male in late 50s presented with a 10-year history of unilateral yellow-white asymptomatic fundus lesions in the left eye. Extensive multimodal imaging and workup for systemic lymphoma, sarcoidosis, autoimmune diseases, birdshot chorioretinopathy, and related infections yielded negative results. Indocyanine Green Angiography (ICGA) revealed hypofluorescent spots in the mid-late frames and fluorescence blockage consistent with fundus lesions. Enhanced-depth OCT revealed choroidal thickening and hyporeflective spaces within the outer choroid corresponding to the lesions. During Fluorescein angiography, the lesions became more iso-fluorescent and stained minimally in the late phase, indicating they are not full thickness and spare the inner choroid. Short-wave autofluorescence was normal. B-scan ultrasound revealed two shallow, lesions without retinal infiltration. Partial lesion regression and progression were observed over time. Steroid treatment aimed at reducing lesion choroidal thickening had a mild effect. Despite discontinuation, the patient remained asymptomatic without vision impairment or intraocular inflammation. The right eye remained unaffected.
Conclusion: Indolent, nonprogressive, multifocal, and choroidal lesions likely represent benign lymphocytic infiltrates localised within the outer choroid. Mild steroid response suggests a non-inflammatory process. The lack of reports presents a gap in ophthalmology. Diagnosis of this case is based on similar presentation of other cases. Surveillance rather than biopsy or treatment is recommended for asymptomatic patients.
