Abstract:  Objective To describe clinical and fundus imaging features of solitary peripapillary choroiditis patients. Design Retrospective case series. Participants Patients diagnosed as solitary peripapillary choroiditis in Beijing Tongren Hospital, Beijing Aier Eye Hospital and Beijing Aier Yingzhi Eye Hospital from June 2013 to January 2025. Six patients (9 eyes) with solitary peripapillary choroiditis were enrolled. There were 3 males (3 eyes) and 3 females (6 eyes) with the median age of 31 years. Three of them had binocular disease at onset of disease. Methods History of systemic comorbidities and results of systemic and ophthalmological examinations, including fundus photography, optical coherence tomography (OCT), fluorescein fundus angiography (FFA) and indocyanine green angiography (ICGA) were evaluated. Cases with infectious diseases or autoimmune diseases were excluded. Follow-up duration ranged from 1 month to 48 months, with an average of 13.1 months. Main Outcome Measures Characteristic signs of fundus imaging. Results In 9 eyes of the 6 patients, the lesion of solitary peripapillary choroiditis was unifocal, adjoining to one side of the optic disc, or surrounding the optic disc in all eyes. The area and severity of the lesion vary from peripapillary retinal pigment irregularity (3 eyes), to optic disc edema （1 eye), peripapillary subretinal yellow-whitish exudation (1 eye), and peripapillary subretinal fibrotic membrane (5 eyes), along with cystoid macular edema and macular hard exudates secondary to choroidal neovascularization (CNV) (5 eyes). In all the 9 eyes, OCT showed discontinuity and blurred reflection of retinal pigment epithelium, (RPE) with underlying choriocapillaris and choroidal Sattler layer atrophy, as well as destruction of the outer retina above. Furthermore, macular edema can be found when secondary CNV arose in 5 eyes. Four patients (6 eyes) received FFA and ICGA. FFA showed ill-defined slightly hyperfluorescent lesion temporally adjoining to optic disc in the early phase, and staining in late phase in 1 eye. In the rest 5 eyes, due to secondary CNV, the FFA showed fluorescence leakage inside the peripapillary lesion, and pooling in late phase. On ICGA of all 6 eyes, persistent hypofluorescence and reduce of choroidal large vessels were seen correspondingly. Conclusions The prominent fundus appearance of solitary peripapillary choroiditis is unifocal lesion adjoining to optic disc or surrounding optic disc. It is a kind of idiopathic choroiditis mainly affected RPE, choriocapillaris and choroidal Sattler layer. Secondary subretinal fibrosis and CNV can be seen.

Key words:  Choroiditis, Retinal pigment epithelium, Choroidal neovascularization, Multimodal imaging