Hyperreflective, Pyramidal-Like Lesions of the Outer Retina and Retinal Pigmented Epithelium in Non-Syphilitic Uveitis: A Case Series.

Purpose: To report pyramidal-like, hyperreflective changes of the outer retina and retinal pigmented epithelium (RPE) in three patients with an atypical non-syphilitic outer retinopathy.

Study design/materials and methods: Single institutional case series conducted at the National Eye Institute, National Institutes of Health.

Results: Hyperreflective, pyramidal lesions of the outer retina and RPE have been described in patients with syphilitic posterior segment uveitis. We report three patients with an atypical posterior segment involving uveitis who were found to have pyramidal-like, hyperreflective lesions extending from the RPE to the outer nuclear layer in combination with associated ellipsoid zone (EZ) loss on optical coherence tomography. All cases had associated choroidopathy and antecedent infectious symptoms. Extensive laboratory investigation including syphilis testing was negative. All cases had an excellent response to corticosteroid treatment with improvements in vision, EZ reconstitution, and resolution of the pyramidal changes.

Conclusion: Hyperreflective, pyramidal-like lesions of the outer retina and RPE can be found in cases of non-syphilitic uveitis. Anti-inflammatory treatment can result in significant anatomic and visual acuity improvements.