Multimodal imaging in Behçet disease uveitis manifesting with sequential bilateral prepapillary inflammatory vitreous exudate

Objective: To describe a case of Behçet disease (BD) uveitis manifesting with sequential bilateral prepapillary inflammatory vitreous exudate (PIVE) documented with multimodal imaging, including swept source optical coherence tomography (SS OCT) and OCT angiography. Material and Methods: A single case report.Results: A 37-year-old man developed sequential bilateral PIVE, initially misdiagnosed as toxoplasmic neuroretinitis, before extraocular features of BD became evident and the patient treated accordingly. SS OCT showed at the acute phase in both eyes a typical “mushroom-shaped” prepapillary hyperreflectivity of the PIVE. SS OCTA demonstrated a corresponding prepapillary hypointense area due to shadowing effect, decreasing in size while scanning deeper layers. It also detected peripapillary retinal hypervascularity in both eyes and a sectoral area of flow signal loss in the first involved left eye. Visual acuity improved following the resolution of the PIVE and associated acute inflammatory changes in both eyes. The left eye showed residual optic disc pallor and retinal nerve fiber layer defects.Conclusion: Sequential bilateral PIVE may occur in the absence of other clinical features of BD. SS OCT and OCTA can provide useful information for the diagnosis and management of PIVE and underlying optic nerve inflammation.