We present a 20-year-old woman who was diagnosed with subacute sclerosing panencephalitis (SSPE) 20 months after presenting with unilateral retinitis. At presentation, the patient had two inferotemporal macular lesions in her left eye. Corresponding to these areas, optical coherence tomography (OCT) showed hyporeflective spaces with loss of nearly all of the retinal layers. OCT-angiography (OCTA) demonstrated some flow deficit areas with a reduction in the vessel density. Her serum measles antibody titre was high (IgG >5000.0 mIU/ml). Twenty months later the macular lesions had diminished in size, and there was some focal retinal thinning with interruption of the ellipsoid zone. OCTA showed that the flow deficit areas were diminished in size together with the relatively improved perfusion density. Neurological examination disclosed myoclonic jerks. Neuropsychological assessment demonstrated impaired executive function, attention, and narrowed lexical fluency. Measles IgG antibody was high in the cerebrospinal fluid (>230.0 U/ml). Brain magnetic resonance imaging demonstrated bilateral, non-specific, small foci of T2 hyperintensity in the frontoparietal subcortical white matter and centrum semiovale. The present case is the first where OCTA findings of SSPE-related retinal lesions have been described.

OBJECTIVE: To describes one case of syphilitic necrotizing retinitis and one case of presumed syphilitic necrotizing retinitis with presence of subhyaloid hypopyon.
METHODS: We report two cases of necrotizing retinitis, which were noted to have yellow boat-shaped lesions at the inferior edge of retinitis resembling subhyaloid hypopyon. The subhyaloid location was confirmed on optical coherence tomography in one case. Both the cases were positive for venereal disease research laboratory test (VDRL) and Treponema pallidum hemagglutination (TPHA). But in one case, polymerase chain reaction (PCR) of the aqueous humor was positive for Pseudomonas aeruginosa and responded well to piperacillin. As piperacillin is effective against Pseudomonas and the efficacy of piperacillin in the management of syphilis is not studied, we may have to consider it as a case of presumed syphilitic retinitis.
CONCLUSIONS: Subhyaloid hypopyon is an uncommon presentation and is reported in two cases of syphilitic necrotizing retinitis in literature. Severe infection and necrosis confined to the inner retina leads to collection of white blood cells and necrotic material in the subhyaloid space and would settle down resulting in subhyaloid hypopyon. Two cases of subhyaloid hypopyon reported in literature and 2 cases reported in our article are syphilitic retinitis and is not reported in other entities.
CONCLUSIONS: It is possible that subhyaloid hypopyon may serve as a diagnostic cue in syphilitic necrotizing retinitis.