Clinical presentation

A 49 year old white man was referred to the Proctor Medical Group in 1996 for evaluation of multifocal choroiditis (MFC). This had been an incidental finding on routine examination by his primary ophthalmologist. The patient was bothered by his refractive error, but denied problems with night or colour vision, and did not notice floaters.

The patient’s past ocular history was notable for myopic correction since childhood. Radial keratotomy (RK) had been performed in both eyes in 1993, with subsequent fluctuations in his refraction. His past medical history was notable for a small cutaneous melanoma removed 5 months before presentation. He had been started on oral prednisone for his MFC before his referral to Proctor.

Best corrected visual acuity was 20/20 in both eyes, and the intraocular pressures were 14 mm Hg. External examination was unremarkable, and the anterior segments showed RK scars and no inflammation. Trace vitreous cell was noted in both eyes. The optic nerve heads appeared pink and healthy, and the vasculature was unremarkable.

Multiple cream-coloured round and oval spots were scattered throughout the posterior poles of both eyes, more prominent nasally (Figs 1A and B). The spots averaged approximately 500 μm in diameter, and were deep to the neural retina. The macula in each eye was flat with appropriate pigmentation. The fundus had a very “blond” appearance consistent with the patient’s complexion.