Presumed non-inflammatory bilateral peripapillary subretinal fibrosis in adolescent patients

Abstract Background To describe two adolescent patients with bilateral peripapillary subretinal fibrosis (PSF) without overt clinical or angiographic evidence of active intraocular inflammation. Case presentation Observational case series of two adolescent patients who underwent comprehensive ophthalmic examination, including color fundus photography, fluorescein angiography (FA), and spectral-domain optical coherence tomography (OCT). Both patients demonstrated bilateral peripapillary subretinal fibrotic lesions with variable macular involvement. In Case 1, the left eye showed macular extension with findings suggestive of a subfoveal choroidal neovascular membrane, associated with intraretinal cystic changes on OCT, while the fellow eye exhibited a peripapillary lesion sparing the macula. In Case 2, the left eye showed macular involvement with marked outer retinal atrophy and increased choroidal hypertransmission, whereas the right eye had an isolated peripapillary fibrotic lesion without foveal involvement. Fluorescein angiography revealed late staining of the fibrotic areas without angiographic signs of active intraocular inflammation; window defect–related hyperfluorescence was observed in areas of atrophy. Visual acuity reduction was observed only in eyes with macular involvement. Conclusions These cases describe a presumed non-inflammatory presentation of bilateral peripapillary subretinal fibrosis in adolescent patients. However, an underlying inherited retinal disorder or subclinical inflammatory or infectious disease cannot be completely excluded because the relevant historical investigations could not be verified. Further studies, including genetic and electrophysiological evaluation, are required to better define the underlying mechanisms.