LONG-TERM FOLLOW-UP OF CHRONIC LYME NEURORETINITIS

Purpose: The authors report sequential fluorescein angiographic and co lor photographic findings of the fundi and response to treatment in a patient with chronic Lyme neuroretinitis. Methods: A Lyme enzyme-linke d immunosorbent assay with purified 41-kd flagellin as antigen was use d to detect immunoglobulin G and immunoglobulin M antibodies to Borrel ia burgdorferi in serum, cerebrospinal fluid, and vitreous. The change s were documented by fluorescein angiography and color photography tes ts performed during a 51/2-year follow-up. Results: The diagnosis of L yme neuroretinitis was based on the history of erythema migrans and po sitive Lyme enzyme-linked immunosorbent assay tests from cerebrospinal fluid and vitreous and by the exclusion of other infectious and syste mic diseases and uveitis entities. Fluorescein angiography results dis closed bilateral chronic neuroretinal edema with areas of cystoid, pat chy, and diffuse hyperfluorescence peripapillary and in the macular ar eas. The hyperfluorescent lesions enlarged despite a 9-month period of antibiotic therapy. Conclusion: Lyme borreliosis may cause neuroretin itis with unusual angiographic findings. Chronic Lyme neuroretinitis m ay be unresponsive to antibiotic therapy.