Is a chronic systemic disease of unknown  cause characterized clinically by aphthous ulacers of the mouth and genitalia,intraocular inflammation , arthritis, cutaneous vasculitis , 

It is twice as frequent in men .  

Notice the marked narrowing and  sheathing of the retinal vessels, pallor optic disc,heomorrhage , Angiography revealed perivascular leakage of fluorescein . 

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Toxoplasmosis .

Toxoplasmosis is the most frequent  cause of focal necrotizing retinitis in otherwise healthy human individuals. It is common in Yemen.

Notice the deep excavation of the scar in the macula.

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Aids. 

Cotton -wool patches in patient with positive HIV .  

Cotton-wool spots sign is the most ocular findings ( approximately 50% to 70% of patients ) .The cotton-wool patches are similar to those occurring in other retinal vascular diseases except that they are generally smaller in size .

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Fungal chorioretinitis and Papillitis.

This patient with papilloedema and posterior multifocal choroiditis was cured  by systemic antifungal drugs.  

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Toxocariasis.

A nematode infection that may appear as a localized , white elevated granuloma .Signs of inflammation are usually absent .

Differential diagnosis was metastatic carcinoma, focal atrophy of the RPE.

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Server Papiloedema.

IN (A,B)Papilloedema,

Hemorrhage  ,Exudation , in a severely hypertensive patient .

D.D

-Cat scratch disease.

-Acute neuroretinitis.

(C) Papilloedema in patient with raised intracranial tension.

(D) papilloedema without the presence of hemorrhage , this means that the pressure on the retinal veins is not sever.

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B

C

D

Acute Posterior Placoid Multifocal Pigment Epitheliopathy.

Note the  multifocal, flat , white , lesions involving the  RPE .

Early angiograms revealed  absence  of background fluorescein in the  region of the  active lesion .

D.D Multifocal choroiditis

In The APPMPE  the visual acuity returned to normal after curing but not in the posterior multifocal choroiditis.

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Appreciation

To Dr Mahfouth Bamashmus for referral.

Early phases of fluorescein angiography demonstrated  dye leakage from the parafoveal retinal capillaries , and later phases show the characteristic picture of CME (see the photograph).

Angiography  can be helpful in the diagnosis of CME in these patients, who often have hazy media that prevent detailed biomicroscopic examination of the macula specially intermediate uveitis.

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In 1916 Theodor leber describe the  clinical syndrome characterized by unilateral loss of vision , optic disc swelling ,macular star in other wise healthy patient .

D.D  Hypertensive retinopathy

Algorafi eye clinic , Yemen  , reported the same picture bilaterally.

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Acute Neuroretinitis.

Rt. Fundus demonstrated the Acute neuroretinitis.

Exudates in the macula, Sheathing around the peripapillaryl veins ( Periphlebitis) .

The angiogram demonstrated  optic disc staining (inflammation ) and swelling.