Multimodal imaging of sympathetic ophthalmia with florid peripapillary choroidal neovascularization - a case report.

Purpose: To report an unusual episode of sympathetic ophthalmia (SO) with choroidal neovascularization. Observations: SO is a rare bilateral granulomatous uveitis that follows penetrating trauma or surgery, typically affecting both eyes and usually detected in the uninjured one. This case report details an exceptionally rare instance of chronic SO with choroidal neovascularization in a 73-year-old male, tracked over 18 months using multimodal imaging. The patient had undergone vitrectomy for retinal detachment in the left eye two years prior, resulting in phthisis bulbi. He initially presented with severe visual loss in the right eye, accompanied by vitreous haze and diffuse chorioretinal lesions. Diagnostic imaging revealed significant choroidal neovascularization alongside Dalén-Fuchs nodules. Despite initial improvement with corticosteroids and immunosuppressive therapy, the patient experienced recurrent inflammatory episodes and new vessel formation over the following years. Conclusions and importance: This case highlights the occurrence of choroidal neovascularization as the disease progresses and emphasizes the importance of early diagnosis and continuous monitoring to manage such complex cases effectively.