Published online Dec 16, 2022. doi: 10.12998/wjcc.v10.i35.13115
Peer-review started: October 7, 2022
First decision: October 27, 2022
Revised: November 10, 2022
Accepted: November 24, 2022
Article in press: November 24, 2022
Published online: December 16, 2022
Processing time: 67 Days and 15.3 Hours
We describe a case of relentless placoid chorioretinitis (RPC) that progressed despite administration of peribulbar and systemic corticosteroids, and was resolved by systemic combined with intravitreal methotrexate.
A 16-year-old male reported painless blurred vision and a temporal scotoma in his right eye for one week. Due to widespread distribution and continuous enlargement, multimodal imaging of the lesions led to the diagnosis of RPC. Lesions in the right eye extended despite peribulbar injection of triamcinolone acetonide, but the progression was immediately terminated by a single dose of intravitreal methotrexate. A new fresh lesion occurred in the contralateral eye despite systemic prednisolone but was resolved by oral methotrexate.
Systemic immunosuppressants should be given upon RPC diagnosis. Intravitreal methotrexate immediately halted progression and may be considered for sight-threatening cases as part of the initial therapy.
Core Tip: Relentless placoid chorioretinitis is a bilateral disease in nature and refractory to corticosteroid monotherapy, which warrants the importance of systemic immunosuppressants given upon diagnosis. Intravitreal methotrexate should also be considered as part of the initial therapy for macula-threatening cases in order to halt progression immediately and preserve visual function.